It's all about the teacher-student relationship.

THERE HAVE BEEN a number of events and innovations that have been projected to diminish the importance of (or completely replace) the teacher in the learning process. Despite information transfer advances (such as written language, the printing press, image capture, voice capture, and the internet), teachers remain critical to the formal educational process. So why do we, as teachers, still exist? The formal education process is no longer about information, and successful teachers have come to realize this. The innovations described above all relate to the information component of the learning process. The ability of learners to access information has increased to the point of absurdity. The role of the teacher now is to help learners effectively identify and evaluate information sources, but this alone does not justify our continued presence in the educational process. The formal educational process is not only about the learning environment. If high-quality design, approach, and execution were enough, all of the preschool children in the United States would be bilingual, reading, and doing arithmetic as a result of Sesame Street. The environment can facilitate learning, but highly effective instruction also occurs in many challenging environments. There is a marked advantage to have remained at the same school for 28 yr. In looking at the rise and fall of courses in both effectiveness and student regard, I am struck by the huge impact of the teacher or, in a team-taught course, the course director. While learning is self-directed, it is the teacher that is accountable for the learning: accountable to the students, to the program, and to themselves. The analogy of “teacher as coach” has been used in the sense of “a guide.” I prefer to emphasize a more aggressive side of coaching, an authority who prepares, trains, observes, evaluates, and corrects. This role parallels the learning cycle described by Kolb, but while the learner is at the center of the Kolb cycle, the coach is impacting each transition but from the outside. Courses flourish when the student-teacher relationship is reciprocal and includes “joint ownership” of the course. We use an external examination (the National Board of Medical Examiners Physiology Subject Examination) as a comprehensive final examination in our course. As the M1 students were entering the spring final examination week, one of them remarked “We’ve got to get going on physiology. We don’t want to ruin Dr. Carroll’s average.” I felt proud . . . that was the evidence of the reciprocal relationship. While learning is an individual activity, the students are also members of a team. Yes, I use prior classes’ performance on the exam to set the bar for what I expect of the current year’s performance. It is good to have a team goal and to have the students accountable to each other and to me for achieving the goal. And the responsibility flows both ways–a student performing poorly is a failure on my part, and I work with them to get them to perform to the best of their ability. There are a number of thought-provoking articles about the student-teacher relationship (2) and how this applies to medical education (1). They make the convincing case that there are multiple formats for the student-teacher relationship, and, not surprisingly, I align well with the description of the Paternalistic model. And on the coaching side, I am much more Vince Lombardi than Phil Jackson. Take the time to develop those relationships–your teaching will benefit from it.