A little teaching

I recently visited the provincial hospital, a large facility sheltered from the main road by towering gates. We began with morning report. Two students sat at a small wooden table in front of the room and Doctor Bitwe, the dean of the medical school, and I sat directly opposite them. The audience filed in and sat along both sides. The students presented a patient that had been admitted overnight. He was a 10 year-old with abdominal distention and profound weight loss over four months. The physical exam demonstrated two large abdominal masses and an ultrasound showed kidneys each 20 cm in size (very large). We discussed the differential diagnosis, the diagnostic modalities and treatment options. There were many similarities to how things worked back home.

After some teaching with the students, we made our way to a small, dimly lit, concrete shack near the hospital ward. Inside, we were greeted by a confident, well-spoken man in a pressed black suit with a fluorescent pink shirt. After brief introductions, he proceeded to lecture for 90 minutes on the advantages and disadvantages of various surgical approaches to prostate cancer. What a juxtaposition! A day prior, I was watching children die from preventable diseases and now I was learning about advanced prostate cancer treatment.

The following day, I gave a lecture about pediatric heart disease. I prepared all week, staying up late and waking before sunrise in an attempt to create a perfect set of slides. On the day of the lecture, I set up in the large hospital chapel with perfect acoustics. Approximately 100 people filed through the door and took their seats. I spoke slowly and paused for the interpreter. I asked questions for the audience and answered theirs. Things seemed to be going well.

Approximately half-way through the lecture, Dr. Bitwe stood-up and walked to the front of the room. He told me that the material was too complicated, I should lecture more quickly and that I should stop asking questions of the audience. Apparently, the students and physicians are not accustomed to an interactive teaching style.

I truly cherish timely, constructive feedback, but this was a bit too timely. I struggled to maintain focus for the remainder of the talk.

Surprisingly, Dr. Bitwe asked me to repeat the same lecture next week with a different audience.


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