Of irrelevant metaphors and engaging lectures

I recently taught a class on difficult doctor-patient communication to first year students. It was originally planned as an interactive playful activity but turned out to be a very serious and engaging discussion on doctor-patient communication. The young first year students never cease to surprise me with their acute awareness and sensitivity to the world around them. I gave the group two scenarios, the first one was a patient who told lies to the doctor and the second one was an elderly father grieving his son’s death because of which his blood pressure was poorly controlled. The students planned a role play of these scenes and did a fantastic job. The class went on well and we ended up discussing various nuances on how to handle a patient who is lying. We discussed why people lie, how to communicate without embarrassing the patient who is lying, how to disentangle the lie from the truth and help the patient adopt the correct treatment behaviour. In the second scenario we discussed the cultural competence that is required for grief counselling.  

I can sense some of the readers wondering why this whole narrative finished so quickly with very little details about the class. Well, I will write the details of this class in a different blog. But this one is not about the content of the class or the proceedings of the discussion. This is about the communication skills of the person teaching the class. A colleague of mine who taught the class along with me was there during the discussion and he observed my class and the discussion. He gave me some feedback about my teaching style and methods, and I am grateful to him for his observations because they helped me reflect on my techniques. 

 

My colleague came to my chamber this afternoon and very politely told me that they wanted to give feedback about a class that I had taught last week. My curiosity was immediately aroused, and I sat up and requested them to proceed. They told me, “Sir, you have a wonderful vocabulary and use some beautiful words while teaching. But some of the students feel lost when they hear you use those words. I think it is important for you to tone down your language a bit if you want your classes to be inclusive.” I was caught between flattery and surprise. Flattery because, I never thought I had a good vocabulary, and surprise because, I have always felt that I am someone who speaks the plainest language and most people in my audience will be able to understand me. My colleague pointed out one metaphor which I had used in the class and said that it was difficult for some students to understand. The metaphor was “brush it under the carpet”. I was talking about acknowledging the grief of the father who had just lost his son in the scenario. I had said, “the grief must be acknowledged, and we just cannot brush it under the carpet”. It was only when my colleague pointed it out that I understood that I had spontaneously used this metaphor. Brushing something under the carpet being the metaphor for hiding something from sight or failing to address some important issue. 

 

This feedback from my colleague gave me a lot of fruit for thought. Nowadays medical college classrooms are very heterogeneous groups. In our first-year class we have people representing 5-6 different states, speaking 6-8 different languages and representing a diverse set of cultures. Gone are the days when a medical teacher could use popular references from regional films or regional folk-lore to drive home a point. I remember many teachers used to refer to popular Vadivel (popular comedian in Tamil cinema) jokes and epithets for comic relief in their classes. This may not be relevant today. Teachers must either appeal to nationally relevant sensitivities or even internationally relevant ones. However, idioms, metaphors, and references are what make a lecture interesting and engaging. I still remember the stories that my teacher of epidemiology, Dr. JP Muliyil used to say to drive home epidemiology concepts. We could connect with these stories because they were culturally relevant. For example, to explain the concept of null hypothesis, a famous international author would use the reference of the Black Swan to talk about nullifying a hypothesis. If you found a black swan, the theory that all swans are white would be nullified, he would say. But JP would make it culturally relevant and convert the swan reference to a crow reference and talk about white crows. In a culturally and geographically diverse cohort of students, finding such common ground is challenging. 

 

I remember JP’s classes with the ever so slight tinge of a Malayali accent and the deliberately slow and clear enunciation of the sentences to emphasize and drive home key messages. Even though some of the concepts he was trying to explain were complicated, the ease of his lecture and the calming voice and the way he explained things, made us feel comfortable and feel like it was easy. No essay on lectures and classes would be complete without mentioning master teacher and guru Dr. K.P. Misra. He was a towering intellectual personality. But his specialty was simplifying the complex principles of electrophysiology with a childlike simplicity and a thick Odiya accent that made the student feel, this is something easy and we should be able to do it. Having listened to hundreds of talks and lectures by Dr. Misra and Dr. JP and other amazing teachers, I have over the years learned that teaching is the art of making things simple. Making things simple does not mean belittling something. Infact, it is the exact opposite of that. I learned from these intellectual giants that only if you immerse in the subject, understand it thoroughly can you simplify it to an extent that is sounds like a nursery rhyme. 

 

Coming back to my colleague’s feedback about the irrelevance of certain metaphors I had used, I am introspecting on it. My colleague also added as a post-script to their feedback that I should from next time, pause and explain each of my metaphors. Their justification was that such metaphors are common and will be used extensively by all people who speak English well and the students who do not understand them should not be left out and must feel included. While I respect my colleague’s opinion and have thought about it a lot, I have a different perspective on this. I go back to Dr. Misra and Dr. JP’s classes. I would be arrogant to compare my classes with theirs, but I am just trying to see what I can learn from my role models about this feedback from my colleague. Neither Dr. Misra nor Dr. JP diluted the use of literary devices in their classes. Their lectures were always laced with literary devices like similies, metaphors, poetry, and stories. Some of them struck a chord with one section of the audience, while some with another section. Each student took home a different message from a typical Misra lecture. But what mattered was whether the class was engaging, whether it stimulated thought, whether it motivated a follow up on the subject. If a class has the ability to do that, I think incomprehensible literary devices are pardonable. When the class is engaging enough, I have had instances where I have gone and looked up the literary reference and learned about it. I hope my students will also be able to do that. My colleague’s feedback has helped me reflect and understand that I need to focus on making my classes engaging. If they are engaging enough, people from diverse cultures will most likely look up and learn the literary devices!