It was number 30 on my bucket list. Getting a Guinness World Records® record title was number 30 on my bucket list. And as of this weekend, I’m in. I completed a 30-hour medical lecture, which put me in position to have the longest medical lecture in history. It’s always cool to check something off your bucket list.
If you don’t have a bucket list, I say, “Why not?” What do you want to do before you die? Where do you want to visit? What do you want to see? Who do you want to be? That list has been very important for me. It has helped me set a direction. I recommend you create a bucket list.
Now, for this 30-hour lecture, I basically did a 30-hour board review course. I’ve had a lot of people talk to me in the past about how I teach along with teaching and learning styles. Today, I want to talk about teaching, how I teach, and tools for others to teach. And in the process, I’m going to talk about how maybe you could learn better.
First and foremost, I believe you cannot teach unless you engage emotion. You can’t teach unless you create intimacy with an audience. You know the times you saw someone speak, and they were intellectually good, but they didn’t move you emotionally? When a speaker doesn’t move you emotionally, there really isn’t any deep learning. There’s just not. You have to be connected to the content and connected to the speaker. You have to see how this content could be used for the greater good, how it could serve you as a clinician.
I spent 12 years teaching at PA schools, and when you’re teaching in an academic environment, in no way, shape, or form do you really need to engage in emotion. You don’t have to, because your students have to get a grade, so they’re there for a reason. But that doesn’t give students any longstanding knowledge. When I started lecturing at conferences, I realized I needed to be more of a theatrical lecturer. I needed to embrace emotion and give people the tools to practice better medicine in a way that emotionally moved them. That’s been really the key to my success.
How have I done it? How have I engaged emotion? To a huge degree, it has to do with vulnerability. You have to put your emotions out there, and talk about your shortcomings. Talk about where you fell short as a clinician, and hopefully steer people to not make the same mistakes. I think too many speakers are more concerned about looking good than serving their audience. I’ve fallen into that trap before. There are times that I told stories where the primary motivation was to make John look good, but that doesn’t serve the audience. Instead, I need to create intimacy with an audience, and that typically is achieved fastest through vulnerability.
Active Engagement Learning
When I teach, I start with baseline teaching and then build on top of it. I build a foundation of content, and then I keep stacking on top of it. For example, I teach that there are five causes of chest pain, and I say, “Who is your PAPPA?” It’s pericarditis, acute coronary syndrome, pneumothorax, PE, and an aneurysm, or a thoracic dissection. I lay that as the base of my teaching. Then I keep stacking on top of it, like a pyramid. I feel learning is a pyramid, and you need to lay a base foundation and keep repeating that. Keep coming back to home base and saying, “Hey, remember our base. Okay, let’s talk about pericarditis.” Then, “Remember our base, and here we have acute coronary syndrome.” I like to teach in a pyramid.
As a speaker, you really need to know your content. You need to create intimacy with your audience using vulnerability. You also need deflection of voice, and know how you use your body and how you look at the audience. I have embraced what I call active engagement learning. Quite frankly, this is how I was able to speak for 30 hours. Guys, I had only two people fall asleep throughout the 30 hours. It was kind of funny to see two people almost fall out of their chair, because they fell asleep. I belly laughed over that a couple of times. I do not feel learning is fatiguing, not when you’re really learning at a deep level. I think when you learn at a deep level, it’s exciting. It’s energizing. It’s actually fun.
I embrace active engagement learning by asking a question. I’ll stress to the audience, “Think it, but don’t say it.” I’m going to ask a question, and I want you to think about the answer. I don’t want you to declare the answer out loud, though. I don’t want you to say the name or what you think is right, because I want everybody to independently think. When people are independently thinking, they’re engaging in a way that’s not threatening. I’m not going to call on anyone, but I want them to think about the answer. What does having 30 to 40 epithelial cells in a urinalysis mean? “Think it, but don’t say it.” Think of an answer in your head right now. After five or 10 seconds, after they thought about it, then I’ll give them the answer.
There’ll be an aha moment. To some of my participants, that pause is very important, because if you just keep preaching at them, they don’t have time to actively think. That active thinking is what, A, keeps them from getting tired, and B, helps them really learn.
My board review courses are typically 10 or 11 hours long for three days straight. What I find is at the end of the day, people are like, “I can’t believe the day is over. It went by so quickly.” The feedback we got from the record-breaking conference was that, overall, we had highly engaged people throughout the whole time. I love that.
Let me give you some pointers as a student. If you’re a student going to any senior conference, you have to understand the context of the conference. Some conferences are very, very easy to ask questions at. I love it when people ask questions. Any conference that you go to, especially a board review course, that does not encourage asking questions isn’t healthy. That’s a program focused on efficiency, not effectiveness.
Clearly, you need a balance of efficiency and effectiveness. You have to be efficient; you have to cover content. More importantly, you have to be effective. If you’re not effective, you’ve wasted time. You’ve wasted everybody’s time. Efficiency is what most board review courses do, where they just read you slides. That’s highly efficient, just not effective. When they blow by content so fast that you can’t process it, I suggest you just go read it yourself.
As a student, it’s important that you ask questions. It’s important that you don’t leave gaps. So, if I use a term like azotemia, and you don’t know what that means, you need to raise your hand, and say, “Hey, can you clarify that?” I understand that as PAs, we learn a little bit differently, and people have different strengths and weaknesses. If I have an orthopedic PA coming to my board review course, I have to make sure that those small terms aren’t going over their heads. So, I won’t just say azotemia, I’ll say prerenal azotemia, where azotemia just simply means their BUN is greater than 24. I’ll keep explaining that, so no one is missing content.
Ask questions. Be humble. You have to learn, and there will always be things you don’t know. That’s okay. You should ask questions, and any instructors and board review courses should encourage those questions, because that’s how you deeply learn. Understand that there’s a really big difference between effectiveness and efficiency. Effectiveness is when you deeply get it, you can apply it on a test or in clinical practice, and that takes work. Efficiency is reading slides.
When you study, you have to be effective, and that means a high degree of recall. You have to be able to recall this content. I highly recommend the four questions of mastery. The questions of mastery are a big part of how I help PAs study for their boards. These are the four questions:
- What’s the pathophysiology?
- How do they present?
- How do we diagnose it?
- How do we treat it?
That’s highly effective. If you can answer those four questions about every single disease out there, you’re in really good shape. You really know the disease.
If you’re a physician assistant studying for your recertification exam, download our free Questions of Mastery study guide!
But that’s not efficient. I can’t just read you those slides. I have to keep retesting you on them. I need to keep asking, “What’s the pathophysiology of Graves’ disease? What’s the presentation? What’s a diagnosis? What’s a treatment?” You have to study for effectiveness, not efficiency. Too many courses out there are really into being efficient. I’m into being effective, because when you really know your stuff, there’s no fear about the test. You get it. You deeply get it.
A lot of people ask me after taking one of my board review courses, “John, how long should it be until I take my boards?” I want to say, “That’s not a valid question. That’s an efficiency question.” I could say, “You could take your boards right now if you effectively know your content.” It’s not about efficiency. It’s about effectiveness.
I don’t recommend studying with board review questions. There are companies out there making millions of dollars off of PAs with bad questions. Test questions are an assessment tool, not a study tactic. People fail their boards because they do too many questions, without mastering the content. The only test questions I think are really good are the NCCPA pretest. The problem is, they only exist for the PANCE. That’s a little bit concerning to me, because we need a way to take a test, see where our deficiencies are, then retake the test and see if we improve. The NCPA is working on it. They’re going to have one out soon. They just don’t have one now.
When you see a test bank that claims something like, “You have an 87% chance to pass,” where did they get that data from? How valid is that number? These statistics give you a false sense of confidence, but these companies have no connection to the NCCPA. If test banks don’t know how the NCCPA is grading, how can they possibly give you a percentage? It’s like a martial arts school that gives black belts out easily. You pay enough money and you get your black belt. Sure, you have your black belt, but can you fight? Can you defend yourself? If not, it’s useless.
I love teaching in a style I call active engagement learning. That’s what I do. Demand more from your education. Demand more from any conference you go to. Are they reading you slides, or are they deeply teaching you? Are they teaching you how to synergize content? That’s something I do. I’m passionately called to teaching for the long term. We give you CME that you remember for life.