Adv Physiol Educ 42:166-168, 2018

THIS WILL NEVER DO

Linda S. Costanzo, Ph.D.

I stumbled into teaching in 1977 with assistance from an unlikely mentor, two lucky breaks, and a sharp-tongued Brit. At the time, I was a postdoctoral fellow in physiology at Cornell University Medical College (now Weill Cornell), where “postdocs” didn’t teach. As workhorses of the biomedical enterprise, we were paid by fellowships that ensured our time was spent on research; we worked crazy hours in basement laboratories in a single-minded drive to get published and to secure more funding.

While many of us would eventually move into faculty jobs with immediate teaching responsibilities, it didn’t cross anyone’s mind to provide us with teaching experience. The reason often cited for “why postdocs shall not teach” is that it would distract from the laboratory, with the obvious dire consequences being fewer publications, less funding, and careers down the tubes.

The other unstated and perhaps surprising reason post-docs don’t teach is that senior faculty are intensely protective of their teaching—whether they are good at it or not, and whether they enjoy it or not. At most medical schools, regardless of what may be said about the benchmarks of publication and funding, teaching is the most visible and immediate faculty status symbol. It’s clung to ferociously, and some aged faculty would rather die at the podium than admit it’s time to pass the baton to a younger colleague. Plum teaching topics were therefore not likely to be freed up for the postdocs waiting in the wings. Opportunity came to us only if a topic was vacated by relocation, retirement, or death—and then only if the topic was considered so difficult or boring that no one else would touch it.

Erich Windhager, then Chairman of Physiology at Cornell, was my postdoctoral advisor. Thus he was both assignor of teaching and protector of my time. A man of few words, he cited no reason when he asked me to give two lectures to the medical students on the microcirculation—a topic that had been vacated by a retirement and was apparently low on the prestige list. By reputation, this is a bland and relatively easy topic in the formidable block of cardiovascular physiology. Apparently the microcirculation was available because those in the know did not particularly want the extra work for so little notoriety.

However, as the novice who was landing her big break, I said “yes” without a millisecond’s hesitation and dove into the research for those two lectures. This would ultimately take me hundreds of hours, justifying the concern about distraction from the laboratory.

It quickly became apparent that I’d managed to come surprisingly far in a biomedical career with only a general notion of the capillary mechanisms I would soon be teaching. Years earlier, as a graduate student in survey courses, this kind of material made little impression. Most of us were attracted to newer, flashier molecular mechanisms, rather than to capillary functions that had been knocking around the medical education buildings for years.

After the survey courses, our educations narrowed sharply into our specialties—in my case, the distal tubule of the rat nephron. Such narrowing left us with a slim fund of knowledge on how the body works in general. These deficiencies might reveal themselves, embarrassingly, at our oral comprehensive examinations, be duly noted by the examining committee (“it is surprising that she didn’t know that”), and then be overlooked. The deficiencies reared their ugly heads again, only much later, when we had to teach. It turns out there is high demand in medical school teaching for how the body works in general and little demand for minutiae of the rat distal tubule. So, I was playing catch-up on the microcirculation in order to establish the basic level of knowledge expected for someone at my stage.

Once the basics were in place, I attacked the cutting-edge literature, looking particularly for areas of controversy that would excite and impress students. The more I researched, the clearer it became that the microcirculation had gotten a bum rap: it was far from bland and easy, and my research revealed that much would need to be culled and condensed to cover it in just two hours. Three-dimensional models of O2 diffusion, and the high-level physics of Starling forces and capillary hydraulics—all beauties ripe for development. The Cornell students were a bright group who would appreciate a rigorous, enlightened lesson on the capillaries. And, with any luck, me by association.

As the date for the lectures approached, Erich inquired about my progress. I was still culling and condensing, but he insisted there would be a rehearsal—soon. For some reason I assumed the two lectures would be private (just me, the students, and my cutting-edge version of the microcirculation); I had missed the point that, as chair, Erich was responsible for everything done in his department’s name. Teaching in the medical school is not a private matter at a single lecturer’s discretion or whim, but a public matter, open to the scrutiny of those with experience. Of course there would be a rehearsal.

The lecture hall at Cornell was steep, amphitheater-style. For the rehearsal, I established myself at the podium down in the “pit,” and Erich took a seat up high in the back row. Otherwise, the room that would usually seat 100 students was empty. For two excruciating hours, I clung to my lifelines (the podium and the dutifully researched notes) as I tore through the microcirculation. Those simple, basic mechanisms that had been known for years—trampled and flung asunder. Those extras on O2 diffusion, Starling pressures, and hydraulics—wild pitches, all of them. The capillaries were out there in free fall, disconnected, illogical, and incomprehensible. The enlightened capillary was dead on arrival.

Although Erich wasn’t directly in my line of sight, I found myself repeatedly looking up at him for any sign of encouragement, of mercy. But no sign came; nor would it. Erich held his head in his hands the entire time—at first (apparently) in concentration, then in visible pain, then finally in resignation. Still, he gave no signal to stop, so I continued. When the end did come, he yelled from the back, as if it wasn’t obvious, “THIS WILL NEVER DO!”

Then topping it off, “TOMORROW.”

I understood from his final command that we would rehearse again, tomorrow, and by then my notes and delivery would be good enough for his first-year medical students.

The sheer brevity of his words—in proportion to how awful those two hours had been—hit hard. In practical terms, it was hard to imagine what remedial steps I could possibly take by “tomorrow.”

With more experience, I would have realized that my errors in judgment had been forecast. Before lectures were given, the teaching faculty met to review the examination. We submitted our questions, which were then critiqued in a free-for-all so vicious it must have served to vent lifetimes of pent-up frustrations.

When my proposed questions came before the group, one particularly edgy colleague, a British woman, took the lead. According to her, never in the history of medical education had such detritus been submitted in the name of capillary function. (Actually, having now read thousands of medical physiology examination questions, I appear to have a fair amount of company in that particular trash heap.) She finished me off by saying: “And, for God’s sake, colloidosmotic is one word.”

Colloidosmotic, with or without the extra physics, is a key concept of the microcirculation. One that every future doctor should know. Her point, and admittedly she had one, was that the person teaching the subject should know it is one word—or nothing else matters. Whether others at the critique were quietly in agreement or simply did not wish to become targets themselves, no one stepped up to soften the blows.

My actual lectures are a blur. I presume they were a tame version of what they would have been without the rehearsals. It seemed that the students were fully in attendance. There was an air of tolerance and support that was practically guaranteed by a one-in-a-million coincidence that created a natural sympathetic advantage for me: I was eight months pregnant. The pregnancy added visual interest to the spectacle and probably piqued curiosity enough to make the two hours endurable. Could we be so lucky that she will go into labor? (The unusualness of this would have made for a high point in the academic year.) I’m not sure what specific lesson can be learned from the pregnancy advantage other than it never hurts to have the students on your side.

By departmental custom, all faculty attended all lectures; and they were seated ominously up in the back row. I suspect most of them were rooting for me, perhaps recalling their own first teaching and the kind soul who lied, “Nice lecture.” And, as is typical of any group in academe, a few must have been just plain annoyed at my lucky breaks.

Why Erich Windhager elected this aggravation is a mystery (since any of the experienced teachers in his department could have easily handled the microcirculation). Especially curious, since Erich himself dreaded public speaking, and teaching in particular. He was stoic, but privately expressed disappointment that teaching did not come easily, even after so many years. He seemed an unlikely departmental chair to place a high value on developing a new teacher, and an even more unlikely mentor to have rushed a postdoctoral fellow into lecturing. However, the simple truth is that one needn’t be a gifted teacher, or even introspective about teaching, to know what is needed.

It is possible that Erich saw in me certain qualities in their infancy that would make a teacher. As postdoctoral fellows, one of our few non-research obligations was to set up the medical student teaching laboratories and then to circulate during the labs to troubleshoot defective wiring and so forth. We bailed out broken polygraphs and replaced buffer solutions while the senior faculty instructed.

Some faculty were notoriously non-attentive in the laboratory setting, and the medical students could find themselves abandoned, with only a postdoc to explain the experiments. Unglamorous as they were, those sessions with the abandoned medical students were the first time I realized I could “explain stuff.” While “explaining stuff” is a long way from delivering a well-constructed, appropriate, clearly spoken lecture, it is the seed from which that grows. I suspect that Erich saw potential, and his gutsy contribution was to push-start me into the high-powered environment at Cornell.

Although he was an unlikely teacher of teachers, he was devoted to his students and their deserving of a first-class education. In this case, he demonstrated his devotion to students by making an investment in the next generation of teachers, and then stood by his investment, albeit roughly. For him, the tension between pushing me into it, and then having to protect the students from me, must have been terrible.

As I look back on my rough entry into the profession, the moment that imprinted was Erich’s furious, unambiguous bottom line: This will never do! And, supporting that bottom line, the lack of minced words, the lack of niceties, and the lack of nurturing. There was nothing to distrust and there was no agenda other than the students’ welfare. Imagine a teaching workshop with a session titled “This Will Never Do!” How much time could be saved and how many losses cut if these words were used more often!

I’ve told my story to colleagues at faculty-development workshops. The near-universal response is: And you dared try teaching again? Certainly Erich’s approach is not one found in the “kindly mentor’s handbook.” (Nor is such bluntness typically advocated, except in the most extreme cases of intractably bad teaching.) But somehow in the bluster and harshness of “this will never do,” I understood Erich’s motive: This is not about you or whether you have a future as a teacher, or whether harsh words will damage you for life or make you want to quit the profession before you start. This is only about the immediate jeopardy of my students.

Now, years later, I’m on the other side. I’m the one inviting new faculty, tracking them down for overdue rehearsals, and checking endlessly on preparation. On occasion, I’ve been more worried than they seemed to be. I’m the one seated up in the back row of an otherwise empty lecture hall, with a new teacher quaking at the podium. Occasionally I’ve even wanted to yell, “This will never do!”

Mostly, however, I’ve taken the soft-pedal approach of finding something to praise, some glimmer of effectiveness in the awkward jumble that is the beginning teacher. That glimmer, no matter how faint, can maintain hope during the long, protracted process of becoming an effective teacher.

Some who succeed will remember a mentor’s kind forbearance. Others will remember a harsh, single sentence as the moment that made all the difference.