Most people who have been through a long training carry a few sentences that are not their own. They arrive unbidden, years later, at a particular moment: a question asked of oneself at a bedside, a warning that surfaces just before a decision, a way of saying let us look again that was learned from someone else’s mouth. The words come with a voice attached, and sometimes with a face and a posture and a corridor. In medicine these inherited sentences are so common that they form a kind of oral tradition, passed from teacher to student to the student’s students, and they are one of the means by which a profession reproduces itself in people who will never read its history.
Voices that remain in the head for years deserve to be taken seriously, because two questions follow from them. What, exactly, is it that remains? And is the teacher we never forget the teacher who taught us best? The second question is the uncomfortable one. A teacher may be remembered for charisma, for theatre, for cruelty, or for a reputation acquired afterwards, and memory is not careful about the difference.
I studied medicine at Sri Guru Ram Das Institute of Medical Sciences and Research in Amritsar between 1997 and 2002, and no teacher of mine, there or afterwards, is named or quoted here. A sentence carried for decades has been worn smooth by remembering; set in print, it becomes a small monument its supposed author never commissioned, possibly in words he never quite said, about a subject on which he may since have changed his mind. What follows is an attempt to think about the category: how teachers’ voices lodge in a student, which of them deserve to stay, and what a former student owes the people whose sentences he still hears.
The Name and the Bearer #
The best portrait I know of a famous medical teacher from the inside is Anton Chekhov’s “A Dreary Story,” published in 1889, written by a physician and narrated by an old professor of medicine, Nikolay Stepanovitch, who knows that he is dying. It begins with his name. He is an emeritus professor and privy councillor, with so many decorations that the students call him the Ikonstand; the list of his famous friends winds up with Pirogov and Nekrasov; abroad his name is mentioned in lecture rooms with the addition “honoured and distinguished.” “All that and a great deal more that might be said,” he writes, “makes up what is called my ‘name.’” Then he describes the man who bears it: sixty-two, bald, with false teeth and an incurable tic, his head and hands trembling. “I am myself as dingy and unsightly as my name is brilliant and splendid.”
The gap between the name and the bearer is the first thing to understand about a remembered professor. Students meet both, but they carry away the name. The professor who becomes a voice in a former student’s head is an alloy of reputation, performance and a few remembered sentences, and the trembling, uncertain person behind them is the part least likely to survive.
Chekhov’s professor is lucid about how the performance works. He still lectures well, he says, and he describes his method in one of the great passages about teaching in any literature. Before the lecture he does not have a sentence ready; he looks round the amphitheatre, says “Last lecture we stopped at…”, and the sentences come. A good lecturer, he says, is like a conductor, doing twenty things at once, reading the score, watching the singer, signalling to the drums. “Before me a hundred and fifty faces, all unlike one another; three hundred eyes all looking straight into my face. My object is to dominate this many-headed monster.” When he sees attention flag, when students begin to look at the ceiling, he makes a pun; a broad grin spreads over a hundred and fifty faces, and he can go on.
Then he adds a sentence that ought to be engraved over every lecture hall. At one and the same minute, he says, the lecturer must play the part of savant and teacher and orator, “and it’s a bad thing if the orator gets the upper hand of the savant or of the teacher in one, or vice versa.”
That sentence is the key to the problem of remembered teachers. Of the three figures in it, the orator is the one most likely to be remembered. The pun, the dramatic pause, the dismissive remark, the striking phrase: these are what lodge. The savant’s careful knowledge and the teacher’s patient sequencing are less vivid, and they are absorbed so thoroughly that the student forgets they came from anyone. A student who sets out, decades later, to name the teachers he never forgot is therefore likely to name the best orators, which is not the same list as the best teachers. Gratitude that wants to be accurate has to correct for this.
Two Kinds of Word #
The voice that remains in a student’s head is not a single kind of thing, and the most useful distinction I know for sorting such voices comes from an unexpected source: the Russian literary theorist Mikhail Bakhtin, in his long essay “Discourse in the Novel,” written in the 1930s and translated into English in 1981.
Bakhtin was interested in how a person comes to have his own way of speaking and thinking, a process he called ideological becoming, and he argued that it consists largely of selectively assimilating the words of others. Those words, he said, come in two broad kinds. The first is authoritative discourse: the word of the fathers, already acknowledged in the past, which demands to be accepted or rejected as a whole. It cannot be played with or partly agreed to; it stands at a distance, fixed, to be recited. The second is what he called internally persuasive discourse, and his description of it is the best account I know of what a good teacher leaves behind. Such a word, he wrote, is “half-ours and half-someone else’s.” It does not stay fixed. It enters into our own words, is tested against new material, argues with other voices in us, and, in his view, is productive precisely because it awakens new and independent words of our own.
Both kinds of word survive from medical training, and they feel quite different from inside. The authoritative kind arrives as a rule: never do this; always do that; this sign means that. It has the force of the voice that first said it, and it is either obeyed or, later, consciously defied. The internally persuasive kind arrives as a question, or a habit of attention: what else could this be? what have we not asked? what would change your mind? It no longer sounds quite like the teacher. It has been merged with the student’s own thinking, reworked by years of cases the teacher never saw, and it continues to develop. It is the more valuable legacy, and the less likely to be credited, because by the time it is useful it no longer feels borrowed.
There is a tradition in north Indian music that makes the distinction audible. In the relationship of ustād and shāgird, master and pupil, a singer learns for years by listening and imitating, phrase by phrase, the teacher’s voice, a mode of transmission sometimes described by the Persian phrase sīna-ba-sīna, from breast to breast. The pupil’s voice becomes, for a long time, a version of the master’s. That is the right method for an art whose substance is a style. A good musician eventually finds his own voice inside the inherited one, and audiences can hear the lineage in it and also the departure. Medicine needs the same arc and a sharper ending. A clinician who still speaks entirely in his teacher’s voice after twenty years has preserved an authority, not inherited a method. The voice should have become half his own.
What the Teacher Noticed #
Ask a physician why a particular teacher stayed with him and the answer, very often, is a story of being noticed. The teacher saw what the student had misunderstood, or saw that he was struggling, or saw something in him that nobody else had seen. The first two are claims about observation. The third is a claim about prophecy, and it needs handling with more care.
Observation first, because it is the core of clinical teaching and the part least often described. A student presenting a case says something that is wrong. A weak teacher corrects the statement. A good teacher asks what led the student to it, because the wrong statement is a symptom, and the underlying misunderstanding is the disease. The student may have misread a sign, or known the fact but misapplied it, or reasoned correctly from a false premise learned months ago, or simply guessed. Each of these calls for a different remedy, and the right remedy cannot be chosen until the teacher has examined the student’s reasoning the way he would examine a patient. Good clinical teaching is, in this sense, a second diagnosis carried out alongside the first.
Medical educators eventually wrote this down. In 1992 a group of family physicians, Jon Neher and colleagues, described what they called a five-step “microskills” model of clinical teaching, which became widely known as the one-minute preceptor. Its steps are disarmingly plain: get the learner to commit to what he thinks is going on; probe for the evidence behind that commitment; teach one general rule; reinforce what was done right; correct what was wrong. What the model formalises is the act of noticing. The first two steps exist to make the student’s thinking visible before anything is taught, so that the teaching can be aimed at the real error and not at the surface of the answer. The model’s popularity suggests how often the step had been skipped. Many teachers, asked a wrong answer, simply supply the right one, and the student learns the fact without learning why he went astray.
A teacher who does notice tends to be remembered, and with good reason: being accurately seen is rare enough at any age to be memorable. But memory has a habit of promoting this kind of noticing into something grander. The story becomes he saw something in me, and the teacher is credited with having perceived, in a confused twenty-year-old, the physician the student later became. Such stories are almost always told backwards. They are composed by the successful former student, who knows how things turned out, and they read the outcome into the teacher’s glance.
Psychology has studied the forward version of this story for decades, under the heading of teacher expectations. The famous starting point was Robert Rosenthal and Lenore Jacobson’s Pygmalion in the Classroom (1968), which reported that children whom teachers had been told, falsely, were about to bloom intellectually went on to gain more than their classmates. The finding became one of the most quoted in education and one of the most disputed. In 2005 Lee Jussim and Kent Harber reviewed thirty-five years of the research that followed. Self-fulfilling prophecies in the classroom do occur, they concluded, but the effects are typically small, they do not accumulate greatly over time, and they may be more likely to dissipate than to grow; powerful effects may occur selectively among students from stigmatised groups; and teachers’ expectations may predict students’ outcomes more because the expectations are accurate than because they are self-fulfilling.
That last point is the useful correction to the retrospective story. A teacher who expected much of a student and was proved right was usually not working magic. He was noticing what was already there: the effort, the questions, the particular quality of attention. He deserves credit for the noticing, which is a real skill. He does not need the credit for clairvoyance that the grateful former student tends to give him, and the student does not need to believe that his career was summoned into being by somebody else’s glance. The finding about stigmatised groups points the other way, and more soberly. Where a teacher’s low expectation meets a student whom the world already expects little of, the effect may be larger and more harmful. Teachers who are remembered for having seen someone are worth setting beside the teachers who are never mentioned because they failed to see anyone at all.
Method Outlives Content #
A saying usually attributed to Charles Sidney Burwell, dean of Harvard Medical School in the 1930s and 1940s, tells new students that half of what they are about to be taught will turn out to be wrong, and that nobody knows which half. The attribution is traditional and hard to document, which is itself instructive: even the sayings about the unreliability of teaching are passed on without a source. But the sentiment is borne out by the history of medicine, which is full of confidently taught doctrines that later evidence overturned.
One example fell in the year my own course ended. For decades, observational studies had suggested that hormone therapy after the menopause protected women’s hearts, and many physicians prescribed and taught accordingly. In 2002 the Women’s Health Initiative, a large randomised trial, stopped its comparison of one combined preparation against placebo early, on 31 May, and published its results that July. Among the healthy postmenopausal women in that trial, over an average of about five years, the overall risks of the preparation exceeded its benefits, and there were more coronary events, not fewer. The trial’s own opening sentence noted that despite decades of accumulated observational evidence, the balance of risks and benefits had remained uncertain. Later analyses would complicate the picture further, by age and by timing, and the history is not a simple story of error. But for many teachers it meant that something they had taught in good faith had to be untaught.
What remains of a teacher whose content has been overturned? Sometimes nothing worth keeping. But often what remains is the part that never depended on the content: the manner in which he handled evidence. A teacher who taught a doctrine as settled leaves behind a former student who has to discover its fragility alone. A teacher who taught the same doctrine with its basis displayed, this is what we believe, this is why, this is what would change it, leaves behind a former student who, when the trial results arrive, already knows what to do with them. The facts were the same in both classrooms. The method was different, and the method is what survives.
Henry Adams, the American historian, tried an experiment along these lines at Harvard in the 1870s, which he describes, with characteristic irony, in The Education of Henry Adams. Asked to teach medieval history, about which he knew little, he decided that a teacher who knew nothing of his subject “should not pretend to teach his scholars what he did not know, but should join them in trying to find the best way of learning it.” He took half a dozen able students, set them loose on the sources, and let them compare results; “the professor refused to profess, knowing no more than his students.” The students worked, he says, like rabbits, and learned to chase an idea through a thicket of obscure facts. Adams was not satisfied with the result, for reasons he gives himself. But the experiment captures something medical teaching at its best has always done at the bedside: the senior who, faced with a case he does not understand, says so, and shows the students how a competent person proceeds when he does not know. That demonstration is content-free. It is also the most durable thing a clinical teacher can give.
Adams himself supplies the necessary caution. His students learned, he admits, to chase an idea “like a hare” through obscure facts, but he knew from his own experience that “his wonderful method led nowhere,” and that they would have to exert themselves to get rid of it in the Law School even more than they had exerted themselves to acquire it. A method detached from any body of knowledge worth having becomes a parlour game. The point is not that content does not matter. A clinician must know a great deal, and know it exactly, and much of what he knows will remain true for his whole career. The point is that the content he was given will be revised, piece by piece, over forty years, and what lets him revise it well is the manner in which he was taught to hold it. A teacher who gives facts without method leaves a former student defenceless against change; a teacher who gives method without facts leaves him with nothing to apply it to. The teachers worth remembering gave both, and the method is the part that tends to go uncredited, because it has long since become the student’s own way of thinking.
Islāh #
The hardest teaching to remember accurately is correction, because it is remembered with feeling, and the feeling distorts.
The literary traditions of Persian, Urdu and Punjabi offer a model of correction that is worth setting beside the medical one. In the relationship of ustād and shāgird among poets, the pupil submits his verses to the master for islāh, a word that means correction, amendment, reform. The master returns them with changes, sometimes a single word substituted, a phrase reordered, a line struck out, occasionally a couplet rewritten. Ghalib, the greatest Urdu poet of the nineteenth century, corrected the verses of pupils by letter, among them his friend Hargopal Tafta, and the practice was common enough that a poet’s lineage, whose pupil he had been, was part of his identity. The essential features of islāh are worth listing. It is addressed to the work, not the person. It is specific: this word, not that one. It is usually given privately, on the page. And the pupil keeps the corrected verse, which is to say, he keeps the improvement as his own.
Medical correction has often been the opposite: addressed to the person, general, delivered in public, and kept by the student as a wound. One of the first attempts to name the problem in print came from an American paediatrician, Henry Silver, who had been one of the authors of the 1962 paper that described the battered-child syndrome. In a short essay in JAMA in 1982 he asked whether the way medical schools treated their students resembled abuse. In 1990, with Anita Duhl Glicken, he published a survey of students at one school: 46.4 per cent said they had been abused at some point while enrolled, and by the senior year the figure was 80.6 per cent. More than two-thirds of those reported at least one episode they rated as of major importance and very upsetting, and about one in six said it would always affect them. A pilot study published in 2015 by Karen Scott and colleagues asked final-stage students at two Australian medical schools about what the authors called teaching by humiliation. Of 146 respondents, 74 per cent reported having experienced it on their adult rotations and 83 per cent having witnessed it. The behaviours were mostly subtle, including aggressive and abusive questioning, and the students’ responses ranged from disgust and regret at having entered medicine to endorsement of teachers who publicly exposed a student’s poor knowledge.
In India the setting for the most memorable corrections has often been the viva voce, the oral examination in which a student faces internal and external examiners across a table, sometimes with a specimen, an instrument or a patient between them. The viva gives a teacher’s voice unusual force, because in it the voice that taught becomes, for a few minutes, the voice that decides. It can be conducted as a conversation that finds out what a student knows, or as an interrogation that finds out what he does not, and students compare notes for years afterwards about which examiners did which. The form itself is not the problem. The problem is that a format designed to test understanding can be used, without anyone ever deciding to use it so, as a stage for the examiner’s performance.
That last finding of the Australian study is the important one. Some students endorse humiliation. And Chekhov’s professor shows why. A student who has failed his examination five times comes to the old man’s house to beg for a pass. The professor refuses, and then admits to the reader: “I feel an impulse to torment the student a little.” He tells the young man he should perhaps give up medicine. A moment later he relents a little, then adds that coming up for the examination another fifteen times will not teach him more science, “but it is training your character, and you must be thankful for that.” The cruelty arrives first, as an impulse; the justification arrives afterwards, as a theory of character. Chekhov, who was a doctor, knew how often the order runs that way.
The defence of the harsh teacher is not foolish, and it is held by many physicians who credit a feared teacher with their rigour. Medicine, the argument goes, is unforgiving; errors kill; standards must be enforced; a student who is never made uncomfortable never discovers the limits of what he knows; and the teachers who frightened students were often the ones who cared most that they should know. There is truth in every clause. Discomfort is part of learning. A question one cannot answer, asked in front of others, can fix a fact more firmly than a week of reading.
But the argument confuses three different things: difficulty, standards and humiliation. Difficulty is the condition of learning; standards are its measure; humiliation is a choice about the manner of enforcing them, and the surveys of students suggest how much that choice costs. The feared teacher is overrepresented in memory for a simple reason: fear makes memories vivid. Students who were helped by gentler teachers forget the help because it became their own; students who were frightened remember the fear and attach to it everything they learned that year. The testimony of survivors, those who stayed in medicine and did well, is then offered as proof that the fear was necessary, while the students it drove away are not present to testify. Islāh is the counter-example. A tradition of poetry with the most exacting standards conceivable, in which a single wrong syllable is a fault, developed a practice of correction that kept the standard and dropped the contempt. The master was severe about the line. He had no need to be severe about the poet.
The Procession #
Chekhov’s story contains a small scene worth recalling whenever a teacher is praised as though he worked alone. Every morning, before the lecture, the professor waits in his study with two other men. One is Nikolay, the university porter, whom the professor calls “my colleague, contemporary, and namesake,” who knows everything that goes on in the four faculties and whose estimates of candidates for office almost always turn out right. The other is Pyotr Ignatyevitch, his demonstrator, who prepares the specimens and materials. The professor is contemptuous of him: industrious, reliable, remembers everything he reads, but “a learned dullard,” a “carthorse,” a journeyman and not a master. When it is time, they march into the lecture room in order. The porter goes first with the apparatus or a chart; then the professor; “and then the carthorse follows humbly, with hanging head.”
The students in that amphitheatre will remember the professor. Very few of them will remember that the preparation they looked at was made by the carthorse, or that the porter carried it in. Chekhov’s irony is directed at his narrator, whose brilliance has not taught him to value either man properly.
A medical education is a procession of this kind, and memory reorders it. The charismatic professor is remembered; the demonstrator who sat with a struggling group in a practical and explained the same thing four times, the technician who showed a student how to handle an instrument, the ward sister who quietly corrected a houseman’s order before it reached the patient, the junior resident who stayed late to teach, the librarian, the classmate who explained it better than the lecturer, and the patients who allowed themselves to be examined, are absorbed into the background. Credit concentrates on a single figure because a single figure makes a better story, and because the dramatic voice is the one that lodged. An honest account of what one learned, and from whom, has to spread the credit thinner than memory wants to.
The patients in that list deserve a sentence of their own. Clinical teaching has always depended on people who allowed students to listen to their hearts, feel their abdomens, ask them the same questions for the fourth time in a morning, and practise on them the manner the students would later use on others. Medicine has an old saying that the patient is the best textbook, and like most such sayings it flatters the profession more than the patient: a textbook does not tire, or feel exposed, or have a family waiting outside. The patients who taught a generation of students are the least likely of all teachers to be remembered by name, and the most likely to have taught something that no professor could, which is what it is like to be on the other side of the examination. A former student’s gratitude that reaches the famous professor and stops there has stopped too soon.
A Quotation Is a Permission #
There is a further reason this essay contains no teacher’s sentence, beyond the general rule of not inventing what one cannot verify. The sayings of famous teachers are among the least reliable texts in medicine. Sentences attributed to celebrated physicians very often cannot be found in anything they wrote; they have been improved in transmission, reassigned to more famous names, and polished by repetition into aphorisms their supposed authors might not recognise. The Burwell saying about half of medicine being wrong is an example in its own right. If this happens to the sayings of the famous, whose writings can be checked, it happens all the more to the sentences of teachers who never published, carried in the memory of a single former student for decades.
Quoting a teacher also does something to the teacher. A private person, perhaps still alive, perhaps still teaching, is made to stand behind a sentence in public, in a context he did not choose, sometimes as the villain of a story about harshness, sometimes as the saint of a story about inspiration. He may have changed his views. He may be embarrassed by the praise or wounded by the blame. He cannot reply. The ethics here are the same as for any real person in a memoir: what was said in a classroom was said under the terms of a classroom, and lifting it into print changes those terms. A former student who wants to honour a teacher can name him with his consent, describe what he did rather than what he is supposed to have said, and leave the sentences in the head where they live, half his and half the student’s, which is perhaps where they belong.
A Teacher Affects Eternity #
The most quoted sentence about teaching in American English comes from Henry Adams, and it is usually quoted as a compliment. “A teacher affects eternity; he can never tell where his influence stops.” It appears on posters and greeting cards. In its place, in the chapter of The Education of Henry Adams called “Failure,” it is something closer to a warning. Adams writes it in the middle of explaining why teaching history frightened him: a teacher is expected to teach truth, and in a subject like history he cannot help making of his students “either priests or atheists, plutocrats or socialists, judges or anarchists, almost in spite of himself.” The sentence is about the danger of influence before it is about its glory.
And the chapter ends in self-judgment. After seven years at Harvard, Adams writes, “As a professor, he regarded himself as a failure.” He had wanted conflict and contradiction in the classroom; he would have liked to seat a rival assistant professor opposite him “whose business should be strictly limited to expressing opposite views,” because nothing short of that would interest either professor or student. The university did not permit it, and he left in 1877, believing the seven years lost.
I find this the most useful thing a famous teacher ever wrote about himself, for two reasons. The first is that Adams was wrong about his influence in the way every teacher is: he could not tell where it stopped, so he assumed it had stopped at the classroom door. Teachers rarely see what their students carry away, and the students rarely tell them. The second is that the thing Adams wanted, a voice in the classroom expressing opposite views, is exactly what a good teacher’s voice becomes in a former student’s head over decades. It does not remain a monologue. If it is internally persuasive, in Bakhtin’s sense, it becomes one side of an argument that the student conducts with himself, and the student supplies the other side out of everything he has seen since.
Punjabi has an idiom for what a student does with a teacher’s sentence. Gall palle baṇnh lai, an elder says: tie this in the end of your cloth. The ਪੱਲਾ, pallā, is the loose end of a scarf or a shawl, and tying a coin or a key in a knot in its corner was, for generations, how people without pockets carried what they could not afford to lose. To tie a word in one’s pallā is to keep advice the way one keeps money: privately, close to the body, ready to be undone when it is needed. The image is exact about the experience of carrying a teacher’s sentence. It goes everywhere with you, unseen, and it is sometimes forgotten for years until a moment at a bedside unties it. But the idiom also implies a duty the grateful usually overlook. A knot can hold a coin or a pebble, and the person who carries it is the one who must, sooner or later, undo it and look at what is inside. Some of what was tied there in one’s twenties turns out to be counterfeit: a prejudice delivered with authority, a cruelty presented as a standard, a fact that has since been withdrawn. Respect for the person who tied it does not require carrying it unexamined for life.
That suggests what a former student owes the voices he carries. Not obedience: a teacher’s authority was a stage in the student’s education, not its conclusion, and respect does not require permanent assent. Not inflated gratitude either: the teacher did not intend a lifelong legacy and should not be credited with one he cannot see. What is owed is closer to stewardship. The voices that remain are now the student’s responsibility, because he is the one who will pass them on, to younger colleagues, to students, sometimes to patients in the form of a manner. He decides which of them to keep, which to argue with, and which to let fall silent. The authoritative voices that taught by fear can be let go, with whatever they contained that was true kept and restated in a kinder register. The voices that asked questions can be kept and passed on as questions.
If I had to say which voice is worth hearing at a bedside in a moment of uncertainty, it would be the one that asks rather than pronounces: the voice that says what else could this be?, what have we not asked her?, what would make you change your mind? Whoever first spoke that voice into a student’s head, it is no longer quite theirs. It has become half his. That is the form of remembrance a good teacher would probably prefer, and it has the merit of being true.
Evidence and Editorial Note #
Documented findings. Public biography relied on: MBBS at Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, 1997–2002. Anton Chekhov, “A Dreary Story” (1889), in Constance Garnett’s translation, The Wife, and Other Stories (Project Gutenberg eBook 1883): the professor’s “name,” “as dingy and unsightly as my name is brilliant and splendid,” the lecture as conducting, “a hundred and fifty faces,” “this many-headed monster,” savant, teacher and orator, the failing student (“I feel an impulse to torment the student a little”; “it is training your character, and you must be thankful for that”), the porter Nikolay and the demonstrator Pyotr Ignatyevitch, and the order of the procession. Henry Adams, The Education of Henry Adams, chapter XX, “Failure (1871)” (Project Gutenberg eBook 2044): “A teacher affects eternity…,” the sentence on priests and atheists, the historical-method experiment (“the professor refused to profess,” students chasing an idea “like a hare,” “his wonderful method led nowhere”), the wish for a rival assistant professor, “As a professor, he regarded himself as a failure,” and departure in 1877. Mikhail Bakhtin, “Discourse in the Novel,” in The Dialogic Imagination, trans. Caryl Emerson and Michael Holquist (1981): authoritative and internally persuasive discourse and ideological becoming, paraphrased from standard knowledge of the text, with one short quotation. Jacques E. Rossouw and colleagues for the Women’s Health Initiative Investigators, JAMA 2002;288(3):321–333 (PubMed abstract, PMID 12117397): trial stopped on 31 May 2002 after a mean 5.2 years; overall health risks exceeded benefits for the preparation studied; coronary heart disease hazard ratio above one; the opening sentence on decades of observational evidence. Henry K. Silver, “Medical students and medical school,” JAMA 1982;247(3):309–310 (PubMed record, PMID 7054531), and Henry K. Silver and Anita Duhl Glicken, “Medical student abuse,” JAMA 1990;263(4):527–532 (PubMed abstract, PMID 2294324): 46.4%, 80.6% by senior year, 69.1% with a major episode, 16.2% “always affect them.” Karen M. Scott and colleagues, “’Teaching by humiliation’ and mistreatment of medical students in clinical rotations: a pilot study,” Medical Journal of Australia 2015;203(4):185e.1–6 (PubMed abstract, PMID 26268289): 146 of 151 respondents; 74.0% experienced and 83.1% witnessed on adult rotations; responses from disgust to endorsement. Lee Jussim and Kent Harber, “Teacher expectations and self-fulfilling prophecies,” Personality and Social Psychology Review 2005;9(2):131–155 (PubMed abstract, PMID 15869379): effects typically small, not accumulating, possibly dissipating; stronger effects possible among stigmatised groups; expectations predicting outcomes partly through accuracy. J. O. Neher, K. C. Gordon, B. Meyer and N. Stevens, “A five-step ‘microskills’ model of clinical teaching,” Journal of the American Board of Family Practice 1992;5(4):419–424 (PubMed abstract, PMID 1496899): the five steps; the name “one-minute preceptor”: standard reference knowledge. Standard reference knowledge: Robert Rosenthal and Lenore Jacobson, Pygmalion in the Classroom (1968); the viva voce in Indian medical examinations; the Punjabi idiom ਗੱਲ ਪੱਲੇ ਬੰਨ੍ਹ ਲੈ and the ਪੱਲਾ; Silver’s co-authorship of the 1962 battered-child syndrome paper and the content of his 1982 essay; the traditional attribution of the “half of what we teach” saying to C. Sidney Burwell; later age-and-timing analyses of hormone therapy; the ustād–shāgird relation, islāh and sīna-ba-sīna; Ghalib’s correction of pupils’ verses by letter, including those of Hargopal Tafta. Vendor representations. None.
Recollection and tradition. Beyond the public biography, the essay asserts no remembered teacher, lecture, correction or sentence. No teacher from the author’s years at Sri Guru Ram Das Institute of Medical Sciences and Research is named, described or quoted, and the general description of the people who teach in a medical school is not a portrait of anyone. The questions given near the end as examples of a questioning voice are offered as the author’s present view, not as quotations. The essay contains no hypothetical scene; all scenes are from Chekhov and Adams, identified as such.
Analysis and forecast. The reading of Chekhov’s three roles, the application of Bakhtin’s distinction to clinical teaching, the argument that method outlives content, the contrast between islāh and humiliation, and the account of what a former student owes a teacher are the author’s interpretation and ethical preference. The essay describes the history of a clinical question and offers no clinical advice. Independence. This essay is not sponsored by any institution, company, health system or technology developer.
About the Author #
Kanwar Partap Singh Gill, MD, traces his family roots to Khadur Sahib in Punjab’s Majha region and grew up in Amritsar. He attended Spring Dale School and completed pre-medical studies at Khalsa College in 1994–1996. He earned his MBBS from Sri Guru Ram Das Institute of Medical Sciences and Research in Amritsar in 2002.
He completed PGY-1 at the University of Arkansas for Medical Sciences in Little Rock in 2007–2008, and PGY-2 and PGY-3 with UCSF Fresno at Community Regional Medical Center from 2008 through 2010. He has practiced medicine in California since 2010.
His career has crossed four distinct information eras: predominantly paper-based medicine, early and fragmented electronic records, the integrated-EHR era, and the emerging age of generative and agentic artificial intelligence.