I recently took a pedagogical risk. At the start of a lecture on delivering bad news, I announced to a class of second-year medical students that I was adding an extra exam to the syllabus. As a group, they were instantly and profoundly distraught but quickly recovered when I told them it was not true a few seconds later. During the lecture, I frequently reminded the students of their emotional response to my bad news. “If that was how you felt about an extra test, can you imagine what it would feel like to be told you had cancer?” Because I had been teaching that group of students for nine months by that point, I was in tune with the general stress level of the class and was confident in their respect for me as an instructor. These factors contributed to the success of the lesson, but I recognize that such a controversial approach must be undertaken carefully. As my director of curriculum affairs put it when I later told him how I had started my lecture, “Only you could get away with that.”
Eliciting an emotional response from students to illuminate a point is not unprecedented, nor is it without merits. The Socratic method is often used in medical education to increase understanding through inquiry. Rather than giving information, a teacher instead asks students a series of questions. The students either come to the desired knowledge by answering the questions or become more deeply aware of their own limits. Teachers must be quite skilled to execute this technique successfully. Simply giving learners answers is far easier, but it is often less effective. Further, the instructor must understand that being on the receiving end of the Socratic method can make learners anxious or uncomfortable. However, if done well, without shame and humiliation, this process leads to better retention of the lesson than if no emotion had been elicited. With this in mind, I offer several points in support of using emotion in teaching.
Emotion leads to better retention of cognitive material.1 Medical trainees are inundated with vast amounts of information daily. Emotion, positive or negative, can provide trainees with seminal learning experiences,2,3 so, as medical teachers, we should be using it deliberately. When our learners later become teachers, they may reinforce lessons to their own students by recalling the ways they learned from us.
Emotion is essential for truly understanding affective material. Being a patient is often a very intense and disempowering experience. As medical students become health care providers, they become so focused on learning the doctor's perspective that they risk losing track of the patient's perspective. Therefore, emotion can and should be used to illustrate the patient's perspective, especially the sensation of vulnerability. For some topics, an emotional reminder can be as effective a learning tool as hands-on practice is in learning procedural skills.
Emotion is used most effectively in the context of a preexisting, positive relationship between a teacher and a learner. Whenever possible, teachers should take into account the learning styles of individual students. Using emotion is much riskier if there is no context for eliciting emotion or if students do not trust their instructor. Ideally, teachers will modify their style according to their learners' needs. This adjustment is easier to accomplish in the context of a preexisting learning relationship.
Just as the physician–patient relationship is not an equal one, neither is the teacher–learner relationship equal. Therefore, teachers can use positive emotion liberally since there are fewer risks, but they must use negative emotion cautiously and judiciously since it is such a powerful tool.
Finally, effective teachers successfully match the emotion they elicit from learners to the teaching point being made in the context of the overall learning environment. Use of emotion in one-on-one learning experiences is more personalized. It is private and therefore safer for both the teacher and the learner, but the teacher may be perceived as targeting an individual student. Using emotion in the group setting, as I did, is more transparent but less personal for the learners. Use of emotion to target an individual in the group setting is very risky and may affect the singled-out individual and the other members of the group differently.
Without including emotion in the learning process, it is impossible to truly engage students. All medical educators should receive formal training on emotional manipulation as a core teaching tool and should feel comfortable using it carefully.
The author would like to thank the Class of 2011 at Alpert Medical School.
1 Schwabe L, Wolf OT. Stress prompts habit behavior in humans. J Neurosci. 2009;29:7191–7198.
2 Kasman DL, Fryer-Edwards K, Braddock CH 3rd. Educating for professionalism: Trainees' emotional experiences on IM and pediatrics inpatient wards. Acad Med. 2003;78:730–741.
3 Pitkälä KH, Mäntyranta T. Feelings related to first patient experiences in medical school. A qualitative study on students' personal portfolios. Patient Educ Couns. 2004;54:171–177.