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Why I teach over my students’ heads

Successful teaching is a work of empathy that stretches the mind.
A blackboard covered in chalk writing and highlights.
James's chalkboard.

I’ve been teaching college students for almost 30 years now. As much as I grumble during grading season, it is a pretty incredible way to make a living. I remain grateful. 

I am not the most creative pedagogue. My preference is still chalk, but I can live with a whiteboard (multiple colors of chalk or markers are a must). Over the course of 100 minutes, various worlds emerge that I couldn’t have anticipated before I walked into class that morning. (I take photos of what emerges so I can remember how to examine the students later.) I think there is something important about students seeing ideas—and their connections—unfold in “real time,” so to speak.  

I’ve never created a PowerPoint slide for a class. I put few things on Moodle, and only because my university requires it. I’ve heard people who use “clickers” in class and I have no idea what they mean. I find myself skeptical whenever administrators talk about “high impact” teaching practices (listening to lectures produced the likes of Hegel and Hannah Arendt; what have our bright shiny pedagogical tricks produced?). I am old and curmudgeonly about such “progress.”  

But I care deeply about teaching and learning. I still get butterflies before every single class. I think (hope!) that’s because I have a sense of what’s at stake in this vocation.  

I am probably most myself in a classroom. As much as I love research, and imagine myself a writer, the exploratory work of teaching is a crucial laboratory for both. I love making ideas come alive for students—especially when students are awakened by such reflection and grappling with challenging texts. You see the gears grinding. You see the brow furrowing. Every once in a while, you sense the reticence and resistance to an insight that unsettles prior biases or assumptions; but the resistance is a sign of getting it. And then you see the light dawn. I’m a sucker for that spectacle.  

This is how the hunger sets in. If you can invite a student to care about the questions, to grasp their import, and experience the unique joy of joining the conversation that is philosophy. 

Successful teaching is, fundamentally, a work of empathy. As a teacher, you have to try to remember your way back into not knowing what you now take for granted. You have to re-enter a student’s puzzlement, or even apathy, to try to catalyze questions and curiosity. Because I teach philosophy, my aim is nothing less than existential engagement. I’m not trying to teach them how to write code or design a bridge; I’m trying to get them to envision a different way to live. But, for me, it’s impossible to separate the philosophical project from the history of philosophy: to do philosophy is to join the long conversation that is the history of philosophy. So we are always wresting with challenging, unfamiliar texts that arrive from other times that might as well be other planets for students in the twenty-first century.  

So successful teaching requires a beginner’s mindset on the part of the teacher, a charitable capacity to remember what ignorance (in the technical sense) feels like. To do so without condescension is absolutely crucial if teaching is going to be an art of invitation rather than an act of alienation. (The latter, I fear, is more common than we might guess.) 

Such empathy means meeting students where they are. But successful teaching is also about stretching students’ minds and imaginations into new territory and unfamiliar habits of mind. This is where I find myself especially skeptical of pedagogical developments that, to my eyes, run the risk of infantilizing college students. (I remember a workshop in which a “pedagogical expert” explained that the short attention span of students required changing the PowerPoint slide every 8 seconds. This does not sound like a recipe for making students more human, I confess.) 

That’s why I am unapologetic about trying to teach over my students’ heads. I don’t mean, of course, that I’m satisfied with spouting lectures that elude their comprehension. That would violate the fundamental rule of empathy. But such empathy—meeting students where they are—is not mutually exclusive with also inviting them into intellectual worlds and conversations where they won’t comprehend everything.  

This is how the hunger sets in. If you can invite a student to care about the questions, to grasp their import, and experience the unique joy of joining the conversation that is philosophy, then part of the thrill, I think, is being admitted into a world where you don’t “get” everything.  

This gambit—every once in a while, talking about ideas and thinkers as if students should know them—is, I maintain, still an act of empathy.

When I’m teaching, I think of this in a couple of ways. At the same time that I am trying to make core ideas and concepts accessible and understandable, I don’t regret talking about attendant ideas and concepts that will, to this point, still elude students. For the sharpest students, this registers as something to learn, something to be curious about. Or sometimes when we’re focused on, say, Pascal or Hegel, I’ll plant little verbal footnotes—tiny digressions about how Hannah Arendt engaged their work in the 20th century, or how O.K. Bouwsma’s reading of Anselm is akin to something we’re talking about. The vast majority of students won’t be familiar with either, but it’s another indicator of how big and rich and complicated the intellectual cosmos of philosophy is. For some of these students (not all, certainly), this becomes tantalizing: they want to become the kind of people for whom a vast constellation of ideas and thinkers are as familiar and present as their friends and cousins. This becomes a hunger to belong to such a world, to join such a conversation.  

This gambit—every once in a while, talking about ideas and thinkers as if students should know them—is, I maintain, still an act of empathy. To both meet students where they are and, at the same time, teach “over their heads,” is an invitation to stretch into new terrain and thereby swell the soul into the fullness for which it was made. The things that skitter just over their heads won’t be on the exam, of course; but I’m hoping they’ll chase some of them for a lifetime to come. 

  

This article was originally published on James K A Smith’s Substack Quid Amo.

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The healing touch in an era of personalised medicine

As data powers a revolution in personalised medicine, surgeon David Cranston asks if we are risk of dehumanising medicine?

David Cranston is emeritus Professor of Surgery at Oxford University. As well as publishing academically, he has has also authored books on John Radcliffe, and mentoring.

A doctor looks thoughtful will holding a stethoscope to their ears.
Photo by Nappy on Unsplash.

In 1877 Arthur Conan Doyle was sitting in one of Dr Joseph Bell’s outpatient clinics in Edinburgh as a medical student, when a lady came in with a child, carrying a small coat. Dr Bell asked her how the crossing of the Firth of Forth had been on the ferry that morning. Looking sightly askance she replied;  

 “Fine thank you sir.”  

 He then went on to ask what she had done with her younger child who came with her.  

Looking more astonished she said:   

“I left him with my aunt who lives in Edinburgh.   

Bell goes on to ask if she walked through the Botanic Gardens on the way to his clinic and if she still worked in the Linoleum factory and to both these questions she answered in the affirmative.  

Turning to the students he explained  

“I could tell from her accent that she came from across the Firth of Forth and the only way across is by the ferry. You noticed that she was carrying a coat which was obviously too small for the child she had with her, which suggested she had another younger child and had left him somewhere. The only place when you see the red mud that she has on her boots is in the Botanic Gardens  and the skin rash on her hands is typical of workers in the  Linoleum factory.   

It was this study of the diagnostic methods of Dr Joseph Bell led Conan Doyle to create the character of Sherlock Holmes.  

A hundred years later and I was young doctor. In 1977 there were no CT or MRI scanners. We were taught the importance of taking a detailed history and examination. Including the social history. We would recognise the RAF tie and the silver (silk producing) caterpillar badge on the lapel of a patient jacket.  We would ask him when he joined the caterpillar club and how many times he had had to bail out of his plane when he was shot down during the war – a life saved by a silk parachute. We would notice the North Devon accent in a lady and ask when she moved to Oxford.  

The patient’s history gave 70% of the diagnosis, examination another 20% and investigation the final 10%. Patients came with symptoms and the doctor made a presumptive diagnosis – often correct - which was confirmed by the investigations. Screening for disease in patients with no symptoms was in its infancy and diseases were diagnosed by talking to the patients and eliciting a clear history and doing a meticulous examination. No longer is that the case.     

At the close of my career, as a renal cancer surgeon, most people came in with a diagnosis already made on the basis of a CT scan, and often small kidney cancers were picked up incidentally with no symptoms. The time spent talking to patients was reduced. On one hand it means more patients can be seen but on the other the personal contact and empathy can be lost.  

Patients lying in in bed have sometimes been ignored. The consultant and the team standing around the foot of the patient’s bed discussing their cases amongst themselves. Or, once off the ward, speaking of the thyroid cancer in bed three or the colon cancer in bed two. Yet patients are people too with histories behind them and woe betide the medic, or indeed the government, who forgets that.  

With computer aided diagnosis, electronic patient records and more sophisticated investigation the patient can easily become even more remote. An object rather than a person.  

We speak today of more personalised medicine with every person having tailored treatment of the basis of whole genome sequencing and knowing each individual’s make up. But we need to be sure that this does not lead to less personalised medicine by forgetting the whole person, body mind and spirit.  

Post Covid, more consultations are done online or over the telephone -often with a doctor you do not know and have never met. Technology has tended to increase the distance between the doctor and patient. The mechanisation of scientific medicine is here to stay, but the patient may well feel that the doctor is more interested in her disease than in herself as a person. History taking and examination is less important in terms of diagnosis and remote medicine means that personal contact including examination and touch are removed.  

Touching has always been an important part of healing. Sir Peter Medawar, who won the Nobel prize for medicine sums it up well. He asks:  

‘What did doctors do with those many infections whose progress was rapid and whose outcome was usually lethal?   

He replies:  

'For one thing, they practised a little magic, dancing around the bedside, making smoke, chanting incomprehensibilities and touching the patient everywhere.? This touching was the real professional secret, never acknowledged as the central essential skill.'

Touch has been rated as the oldest and most effective act of healing.   

Touch can reduce pain, anxiety, and depression, and there are occasions when one can communicate far more through touch than in words, for there are times when no words are good enough or holy enough to minister to someone’s pain.   

Yet today touching any patient without clear permission can make people ill at ease and mistrustful and risk justified accusation. It is a tightrope many have to walk very carefully. In an age of whole-person care it is imperative that the right balance be struck. There’s an ancient story that illustrates the power of that human connection in the healing process. 

When a leper approached Jesus in desperation, Jesus did not simply offer a healing word from safe distance. he stretched out his hand and touched him. He felt deeply for lepers cut off from all human contact. He touched the untouchables.   

William Osler a Canadian physician who was one of the founding fathers of the Johns Hopkins Hospital in Baltimore, and ended up as Regius Professor of Medicine in Oxford,  said:  

“It is more important to know about the patient who has the disease than the disease that has the patient”.  

For all the advantages modern medicine has to offer, it is vital to find ways to retain that personal element of medicine. Patients are people too.