Psychiatric Educator Emphasizes the Relational Nature of Teaching

“Education is all about understanding students, what they are interested in and curious about, and helping them to develop themselves. It requires an intellectual and emotional openness to understanding where the students are coming from and where they want to go and helping them get there on their own.”

Courtesy Richard Summers, M.D.

So said psychiatric educator Richard Summers, M.D., chair of APA’s Council on Medical Education and Lifelong Learning. He is one of a cadre of psychiatrists, vital to the future of the field, who has made education a principal component of his career. It is an endeavor that draws on communication skills, empathy, and passion, combined with an authority that comes from a master’s command of the material.

As co-director of the psychiatric residency program at the University of Pennsylvania (UPenn), Summers teaches didactic courses (mostly in the area of psychodynamic therapy), supervises clinical case conferences, and leads a weekly assessment clinic with third-year residents where they are taught how to interview new patients. Additionally, he maintains a clinical practice that covers medication management, combined psychotherapy and medication management, and long-term psychodynamic psychotherapy.

In any teaching venue—in the lecture hall or clinical case conference or at the bedside consulting with a resident about patient care—Summers stays alert to the “teachable moment,” when mere information can be received as wisdom. “In the back of my mind there are things I want to impart to my students. I wait for the moment it seems salient to bring them out and talk about them,” he said. “So for me, a good educational experience has a freewheeling spontaneity about it, where the teacher has a store of vital information—a command of the information—but more importantly knows how to bring it out in a way that is timely and relevant.”

Summers’ ability to identify and capitalize on such teachable moments has not gone unnoticed. Summers received the UPenn Department of Psychiatry’s Earl Bond Outstanding Teacher Award in 2000, the Robert Dunning Dripps Award for Excellence in Graduate Medical Education in 2007, the Psychiatric Educator of the Year Award by the Philadelphia Psychiatric Society in 2007, and the UPenn Provost’s Award for Teaching Excellence in 2014.

In an interview with Psychiatric News, Summers described the path that led him to education, trends and future directions in education, and the qualities that make for a memorable educational experience.

Teaching Holds the Teacher Accountable

As is perhaps true with many physician-teachers, Summers came to teaching more by accident than by design. Following his psychiatry residency at the Institute of Pennsylvania Hospital, a former psychiatric hospital located in Philadelphia, he was an attending psychiatrist on an inpatient evaluation unit when he was asked to become the unit’s director.

“It was a teaching unit, with residents and medical students, and I took the position thinking it would be a clinical and administrative role,” Summers said. “But what I realized was how much fun it was to teach residents and medical students. Not only was it interesting to see how people learn and develop, but it challenged me to think critically about what I was teaching. So it held me accountable for the clinical care I was delivering.”

Five years later, when the residency training director at the institute retired, he was asked by the chairman if he was interested in taking the position. “It had not occurred to me that he saw me as an educator, but almost as soon as he asked me, I realized it was something I wanted to do,” he said.

When the institute, which had been an affiliate of UPenn, was sold by Pennsylvania Hospital in 1997, Summers was named associate director of education for residency training at UPenn, where he coordinated the merger of the institute’s residency program with university’s. In 2008 he became co-director of residency training at UPenn with Anthony Rostain, M.D.

By this time, Summers had become—without quite planning on it—“an educator,” but in retrospect he said it was a natural progression. “Both of my parents were professors and economists at Penn, and I have two uncles and a brother who are university professors,” he said. “I grew up steeped in an academic environment—so when I got into psychiatry, I tapped into something that had been part of my life from the beginning.”

Jury Still Out on New Teaching Models

Education is changing, and at least one version of the conventional wisdom holds that didactic lectures—teacher standing at a podium and talking while students furiously scribble notes—are on the way out; in their place (so the wisdom goes) students will have greater access to online materials that will transform the classroom experience into an arena in which teacher and students together explore the material.

“Surely we need to have an openness to new modalities, and certainly a lot of time is wasted in lectures,” Summers said. “But I think the jury is still out on a lot of the new things we are trying. I’m concerned about the amount of variance there is likely to be from student to student with regard to how much time they really spend reviewing online materials. And I’m concerned that students don’t pay the kind of attention to subject matter they would in a classroom.”

Nonetheless, Summers said he thinks the concept of having students explore more content on their own and in groups—with the teacher more of a facilitator than a dispenser of information—is a good one, if the entire culture of the institution supports it. Psychiatrist Ranga Krishnan, M.D., former dean of the Duke University-National University of Singapore (NUS) Graduate Medical School, described such a culture at NUS in a lecture at this year’s meeting of the American Association of Directors of Psychiatric Residency Training Programs (Psychiatric News, May 1).

What is vital to retain, Summers believes, is the relational and emotion-laden nature of teaching and learning—a concept best summed up by the late poet Maya Angelou who said, “ ‘People will forget what you said and what you did, but people will never forget how you made them feel.’ I think that really speaks to the impact of teachers and education,” Summers said.

Such experiences can happen in traditional learning venues, including the lecture hall when gifted lecturers inspire their students to “feel” the subject matter. But it happens, perhaps most powerfully, in those moments of bedside “informal” education, outside of the classroom, when teacher and student confer about clinical care in “real time,” Summers said.

“Informal education embodies all the principles of problem-based teaching, opening a dialogue between a teacher and student at the immediate moment when learning becomes highly salient,” Summers said. “I think that most doctors, when they think back on their own training, will remember most vividly those moments of bedside teaching when someone caused them to think about patient care in a new way.”

The ability to do that—to seize the moment for imparting knowledge that can be transformative—requires clinical (and life) experience that comes with time.

“There’s a career life cycle to teaching,” he said. “I always felt I was a competent clinician and educator, but it wasn’t until my mid-40s that I began to have the feeling I had something unique to say. I’d been teaching for at least 15 years and I hope I was doing a credible job, but it wasn’t until then that I felt I had the inner experience of providing my students something new, something borne out of my own experience.” ■