On teaching medical trainees, hematologist says to ‘put yourself in their shoes’
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A good teacher in any area of medicine can define a student’s path and course of specialty.
Sparking interest and training fellows in classical hematology — a field with dwindling trainees and growing numbers of retirees — is especially important and a focus of Rakhi P. Naik, MD, MHS, associate professor of medicine and associate director for hematology of the hematology/oncology fellowship program at Johns Hopkins University.
But before becoming granular about training, the approach to recruiting trainees in hematology should be broad, Naik said.
“We can’t focus on just one little aspect of the profession,” Naik told Healio. “We have to think about growing the hematology field fully first and generally sparking interest in it before we can start thinking about hyperfocusing on a sub-sub-specialty.”
Healio spoke with Naik about how she has developed her teaching style and the importance of recruiting students in the field of hematology, especially benign hematology.
Healio: What has been your experience working for and teaching at John Hopkins?
Naik: I work in multiple capacities, all throughout trainee education. I’m the course director for the first-year medical school course in hematology, I am chair of one of the internship selection committees for incoming new applicants into residency and I also direct the Hopkins hematology fellowship track. So, I really am involved in education all along the training spectrum.
I have found that it’s very different teaching to different levels of trainees. In medical school, there is a focus on fundamentals and physiology. Then at the fellowship level, the focus is on clinical care and cutting-edge treatments. It’s really fascinating to watch how trainees build upon their clinical knowledge as they move along through their training.
Healio: What would you say makes a good teacher of medicine?
Naik: One of the most important skills of a good teacher is understanding each trainee’s knowledge level and then building upon that. I change my teaching style depending on the knowledge level of my audience, and not doing so is one of the most common pitfalls that teachers fall into. You may assume that the same educational lecture can work for any level of trainee but, the truth is, if you target the wrong learner level, you may lose your audience. For example, we often don’t remember what it was like to be an early trainee. We forget that in medical school, students lean the equivalent vocabulary of a whole new language. So, teaching at the medical school level must involve teaching the definitions of basic hematology terms or even explaining Latin roots, like “hemo means blood.” Focusing on this basic terminology provides a foundation to allow medical students to even start to understand clinical content.
Healio: Do you have any advice for teaching different levels of understanding?
Naik: The more we become removed from the trainee level, the harder it is to remember what we didn’t know — to put yourself in their shoes. As I developed my own teaching style, I spent a lot of time reminding myself of what it was like at a certain trainee level and putting myself back in those shoes.
It also is important to constantly check in with your trainees to make sure they are understanding concepts. For instance, our hematology division has a joint attending-fellow case conference every Friday. When I checked in with my fellows in the middle of the year, turned out that they weren’t grasping any of the information because the attendings were speaking at a very advanced level, and nobody was taking the time to stop and remind them of underlying pathophysiology. So, we started to think about ways in which we can incorporate fellows better and we did so in two ways.
One is that during our conferences now, we take fellow-level notes during all case presentations that we present at the end of the session to recap important concepts and reiterate the context in which they were learned. That way, the flow of the case presentations remains intact but we ensure that fellows leave the conference understanding the important points.
The second thing we did is that we now have fellow-specific conferences, which provide a safe space for fellows to talk through cases at a more basic level with a single faculty expert.
Healio: How important is it training these hematology fellows, especially as the field begins to whittle down with retirements?
Naik: I would say that education and training are one of the most powerful recruitment tools we have and this is something that is often overlooked in academics. There are very few trainees going into classical hematology in the first place. Often, in academics, we focus on recruitment on the wrong end of the spectrum. For example, we focus on the shortage of hematology fellows going into basic science, forgetting that we first need to build the general workforce. We have a shortage in all aspects of classical hematology from clinical care to education to traditional research. It has basically become a pipeline issue. How are we going to train only basic scientists when trainees aren’t going into classical hematology in the first place? This is why education and training become some of the most important things we can do. We need to recruit trainees and spark their interest in this specialty first to build the workforce. The more trainees we recruit, the more likely future generations will view hematology as a viable career. Only after that should we focus on specialized aspects of research or clinical care.
Healio: Is there any concern about retainment at that later level?
Naik: Academics is having a problem with retention throughout all specialties. In terms of classical hematology, building a community of hematologists within an institution is key for retention. A lot of the retention issues in classical hematology end up being when a physician is recruited into an institution where they are the sole benign hematologist. They feel very isolated because they don’t have a community within the center. Making sure an institution has a critical mass of faculty and a breadth of expertise really helps physicians, especially in the early faculty phases, feel a sense of belonging and helps remind them of the constant excitement around the field.
For more information:
Rakhi P. Naik, MD, MHS, can be reached at rakhi@jhmi.edu.
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