TEACHING
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.
I had a perfect
control of both English and Hebrew. My single disadvantage was impatience with
the students, who often would not concentrate on the discussion, and the nurses,
whose activities sometimes interfered with the flow of teaching.
As we received more
space and moved the department to the eighth floor, I built a large teaching
room using the most modern teaching methods with computers, overhead
projectors, and we had discussions of recent research and simple seminars to
introduce new material into our clinical practice.
Many years later I
would meet my former students who are now heads of the army medicine, directors
of hospitals, and leaders in different departments. They would always joke
about the precise teaching methods and how much they had enjoyed studying
cardiology as undergraduate students.
Teaching was my
greatest investment in medicine in Israel and I had the opportunity to
influence at least 50% of the students who passed through the Hebrew
University.
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