The “KIST” Principle of Teaching

Staff in Hematologic Oncology and Blood Disorders, Taussig Cancer Center, Department of Cellular and Molecular Medicine (NC10), Cleveland Clinic Lerner Research Institute, Ohio

I have been practicing hematology for a long time. I have attended many ASH meetings, including innumerable education, scientific, and poster sessions. After every session, I am rather astounded by how much I don’t know. I have the same impression after leafing through the most recent issue of Blood, or most other journals.

When I received my first faculty appointment at the University of Pennsylvania, I was asked to take on the annual platelet and hemostasis lecture to medical students. I put a lot of time into preparation for this assignment – incorporating what I considered to be timely information on the latest in platelet function and hemostasis. I was, to say the least, quite disappointed when I received the summary of the student’s evaluations of my lecture. However, the pain was somewhat alleviated when I learned that some of my colleagues with considerably more seniority fared even worse!

The students’ dissatisfaction with my lecture focused mainly on the inclusion of too much information. “Too much information?” I asked. “How could that be when I didn’t even include the latest research findings? Don’t they understand how interesting and important this is?” I wondered.

The answer was “No, they didn’t.”

And, like it or not, part of my education was to learn to accept and appreciate the fact that they didn’t. Even more importantly, they probably could become effective physicians without knowing all of this material.

Hence, though the term was not in common use at that time, I realized that an effective teacher must, particularly with complex topics, learn to follow the “KISS” design principle developed by the U.S. military: “Keep it simple, stupid!” However, since I like to think that all of us who have the skillset to teach medical students, residents, and fellows are actually quite intelligent, I have changed the phrase to “KIST”: “Keep it simple, Teacher!”

Why KIST? First, after a few days of self-analysis following each ASH annual meeting, I have been able to reassure myself that not knowing everything discussed in the Education and Scientific Sessions is OK. This material is actually very complex, is constantly changing and being updated, and is always delivered by experts in the field who have spent months preparing state-of-the art presentations. In fact, if I come away from most of these discussions being familiar with 75 percent of the material, I am probably doing quite well. And this is in the context of having attended ASH meetings for almost 25 years and having a solid foundation in the understanding of many hematologic disorders.

Teaching is essentially an exercise in effective communication. Effective communication requires a firm understanding of the skills, limitations, and knowledge base of the individuals with whom you are attempting to communicate. These characteristics differ significantly among cohorts who we teach – students, residents, fellows, mid-level providers, etc.

In other words, it is important to try to “step into the shoes” of those we teach. To do this effectively, we need to understand both the limited experience of our students, and the extent of our own knowledge. In my estimation, the latter is what we fail to appreciate; through many years of practice, attending the ASH annual meeting and other clinical and scientific meetings we cannot help but assimilate a vast body of knowledge that we often take for granted.

Thus, the second reason to consider KIST: What seems simple to us, perhaps overly so, may not be simple to our students. A conscious effort to recognize and stress the basic, core principles of our topics is essential to the “art” of teaching.

This argument is not meant to imply that we should avoid incorporating contemporary scientific knowledge and principles into our teaching. In fact, one might argue these principles have fallen victim to the movement toward case-based teaching (which I personally endorse) and the emphasis on documenting “clinical competencies” in trainees. However, given the abundant scientific advances in recent years, a strong scientific knowledge base – including an emphasis on pathogenesis – is critical not only for trainees with a primary interest in science, but also for the enrichment of future thought leaders who will develop new approaches to clinical disorders.

We approach this issue in our training program by encouraging our lecturers to emphasize the scientific basis of their disease-based lectures and encouraging fellows to begin planning primary research projects, often with a strong translational component, during their first year of fellowship training. Developing a well-conceived and rigorously reviewed plan optimizes the chances of completing a meaningful body of research during their fellowship.

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