I had three goals for the department: clinical service, research and teaching. Apart from two years in Rhodesia, my entire life had been spent in teaching hospitals. Teaching and education was a pivotal and fundamental building block of my presence in the teaching hospital.
In 1973, I found myself running the introductory course in cardiology to the 4th year students and undertook the brunt of the teaching, first in English and then in broken Hebrew.
I had brought English and South African clinical bedside medicine to a country which was based on European and American tradition and instrumentation with an emphasis on special tests, with little associated physical examination. I introduced the basics of physical examination to my residents in the out-patients and to the departments of internal medicine. The impact was great and soon Prof. Eliakim and all his staff would join me on the grand rounds. I applied myself to the students using the basic system of careful history taking, meticulous physical examination, precise analysis of the ECG, x-ray interpretation and only then analysis of the laboratory tests, echocardiography, and finally cardiac catheterization and angiography. All of these were integrated into the final clinical diagnosis for correct prognosis, treatment and management. This logical approach upset my clinical and surgical counterparts and it took some years for them to slip seamlessly into this clinical pattern.
I had to undertake most of the teaching myself and although the teaching staff expanded gradually, I continued to provide the major portion of the teaching thrust. We soon had elective students in the final year, and since they came in small groups of 6 students, this meant that every day we had students for 6 – 8 hours for 8 months of the year.
This was a heavy burden, since I became very active in the cath lab, operating room, and wards.
We had inadequate teaching space, as the students were squashed into our small seminar room and at one stage, I was given a small laboratory the pharmacology building to give seminars. It was very inconvenient, but it gave me good, physical exercise. In later years, Penchas would joke and say that Gotsman had brought the 3rd heart sound and the cardiac catheter to Jerusalem.
We produced teaching pamphlets for the students using the power points presentations, but I had the feeling that they liked to have all their information pre-digested like porridge for breakfast.
We attracted many foreign students who came to Jerusalem for elective periods, and I took them under my wing. They were great fun. They were enthusiastic, very intelligent, and were well-educated, and I created a very special personal relationship with them. I took them into my private clinic, and between the patients and a white teaching board and colored pens, we were able to create a very personal teaching relationship. When I met them in later years, it was clear that this period had made a great impression on them.
The modern approach frowns on formal lectures to large classes, but I still believe that a well-prepared and organized lecture, given slowly without any time constraints, provides the student with a framework for understanding and digesting the material. Seminars of six to eight students provide intimate and personal eyeball contact with the students but this requires repetition of the material and is time consuming. I enjoyed these seminars, for which I not only produced outlines and power point presentations, but also used the white board and colored pens. I was a little disappointed by the students, who would simply listen passively and try to understand the material, but they rarely asked questions or took down notes. Ward rounds and bedside teaching was always very exciting. It provided intimate interaction with the patients, resulting in a close patient-student-teacher interaction. It was easy to determine the pace of the teaching and to appreciate how well the students understood the subject. I used the Socratic method of question and answer. Once again, a group of six students was too large, and I often divided large groups into two small sub groups. Often, I crowded too much material into a discussion on a single patient.
I had my own techniques of careful history taking, based on years of clinical practice: Unhurried, detailed, and comprehensive. Physical examination followed a precise pathway so as not to omit significant details, electro-cardiography gave a careful insight into the electrical and anatomical aberrations of the heart, detailed analysis of the echocardiogram, careful interpretation of the silhouette of the heart, and nature of the lung fields on x-ray, and then interpretation of the special tests. Differential diagnosis today is a lost art, but then it was an accurate diagnosis, often of multi-organ disease, knowledge of the prognosis and trajectory of the patient, and finally, an understanding of the physiological and pharmacological basis of treatment. If the patient needed an intervention, the procedure would be discussed together with its advantages and disadvantages.