I have taught medical students for over forty years and, after a difficult start and the occasional hiccough, it has, overall, given me enormous satisfaction. Of the key components of teaching – lecturing and nurturing – lecturing was a particular challenge. Lecturing is, if nothing else, a public performance, and my beginnings as a performer were hardly auspicious. Up until my late teens I would simply freeze if placed in front of an “audience,” whether it was parents at the school play or simply my classmates.  Faced with speaking out loud my tongue failed to move, and with reading a text the page would become invisible.

Whatever the cause – shyness, something to do with my “dyslexia” (learning and reading were painfully slow) or my family circumstances (my mother was a successful actress) – by the time I was a medical student the problem was no longer incapacitating but it still made life difficult for me, and no doubt my audience too.

In my mid twenties (by then a lecturer), I went on courses to learn how to speak but these offered little. It was not until I was a researcher in Professor John Vane’s laboratory that I learned what lecturing was about. He was a truly superb speaker and his insights made such obvious sense. Moreover, all of his ideas felt achievable. Gradually my fear of speaking and the level of my performance lifted.

Based on his insights, whenever I speak, I strive to present facts and ideas in the form of a story. Like a good story the presentation will have a beginning (scene setting), a middle (for the detail, and actually the crucial part of the talk) and an end (summary and closure). I never skimp on the “scene-setting” period for it is also a time when the audience is settling down (so would take in little detail), and one in which I get a chance to gain the audience’s confidence. It is my belief that confidence in the speaker allows the listeners to relax and to let the ideas flow in (audiences cannot cope with speakers who lack some form of authority and who do not appear to be “in control” of the occasion, the information, or themselves).

During the “talk” there will be mini plots and the occasional diversion to keep listeners on their toes, but the story will follow a logical course in which there are no gaps and no inconsistencies. If I use illustrations I take special care to use a pointer to show the audience around, and do this as though I were “describing to someone a room in my own house” (one of John’s aphorisms, and an issue about which he was particularly insistant). Jokes or asides are a possibility but need some forethought (a few seconds should be enough), and can go wrong (disastrously sometimes).

I strive to address members of the audience as individuals (speaking to an impersonal horizon is not engaging), and do everything necessary to be “in touch” with them. There is no place for reading from a text as this stops any spontaneity and also means that one’s eyes are directed at the page rather than those in the auditorium. I avoid standing behind lecterns as these raise real barriers. I strive to speak clearly (in lecturing, mumbling is a sin!), and ensure that I am audible (and my visual aids visible)  at the back of the auditorium. I strive to stick to the title, keep to time, pitch the talk at a level and context compatible with the needs of the audience (the same topic should be covered very differently for medical students or specialist colleagues), and to have something in the talk for everyone. 

The nurturing side of teaching has been a different challenge, and my approach greatly influenced by the things that helped me overcome my own learning problems. In the medical curriculum, clinical pharmacology is one of many competing subjects and for some it feels daunting. As a teacher the (nurturing) job entailed making the students feel comfortable with the discipline and making it unthreatening, understandable and manageable. To this end, whatever I did (lecturing, tutoring, running seminars, supervising, writing lecture notes), I strived to establish an environment where there was a warmth for the subject, to help create a “nest” in which each student could feel confident; to weave an information network on which they could ‘hang’ facts in an integrated manner; and to build a launch pad from which they could ultimately propel themselves.

But in all this there were conflicts to be resolved. At one and the same time I would have to avoid applying pressure, but make clear what standards needed to be achieved; to avoid exposing ignorance, but point out errors when they occur; to urge students on but not to bully; to congratulate those who excelled, but not undermine the efforts of those achieving less, and so on.

My solutions were to recognise the conflicts and the dilemmas they present; apologise when my call was wrong (and all too often it was); know the students individually and tailor help and advice to their particular needs; and to assume I was to blame if my lectures were not understood, if misunderstandings occurred, or if students failed. Moreover, in whatever I have done, I have strived to avoid the sorts of behaviour (bullying, belittling, demanding, dismissing, harrying) to which some of my own teachers had resorted, and which were so unhelpful to me when I was having difficulties.

Being a teacher has been challenging, fascinating and fun, and moreover a cornerstone of my career. The most unpleasant moments have been when I have (inadvertently) said things that have hurt or undermined (the effect of these can be very difficult to reverse however hard one tries). 

The most heartening experiences have been: seeing students suddenly understand things where previously there was nothing; helping students overcome difficulties and then go on to blossom; having students be confident enough to be critical (of my views/behaviour) without their being afraid; watching the joy of students when they succeed; being “adopted” by students and then sharing with them ideas and reminiscences after they have qualified. Seeing some of my ideas persisting down the generations is pretty good too. 

Joe Collier is emeritus professor of medicines policy at St George’s, University of London