The Human Side of Teaching and Medicine – Dr. Masha Gouzman-Allouche, Senior Teacher, Faculty of Medicine at Tel Aviv University

Dr. Rishi Desai: Hi, I'm Dr. Rishi Desai. As regular listeners to Raise the Line have heard many times from medical educators we've interviewed, the pandemic has caused significant changes to medical education in the U.S. and around the world. One of the most impactful has been the integration of online learning and increased use of other educational technology. Now, our guest today is well-equipped to help us understand the impact of this change and how technology can impact student retention, engagement, and satisfaction.

Dr. Masha Gouzman-Allouche is senior teacher of the Faculty of Medicine at Tel Aviv University, where she's responsible for improving how teaching and learning is happening. She's also a researcher on this topic, and has taught at several medical schools around Israel. Dr. Masha Gouzman-Allouche, thank you so much for being with us here today.

Dr. Masha Gouzman-Allouche: Thank you so much.

Dr. Rishi Desai: Let's start with learning a little bit more about you. What got you interested in medicine and specifically medical education?

Dr. Masha Gouzman-Allouche: I've always felt that working with people makes me happy. In my mandatory military service, I served as a social worker for soldiers. And after that, I was eager to start studying, but I couldn't decide between my high school love, biology, and the subject I always liked to read about, psychology. Luckily for me, the Hebrew University of Jerusalem offered a degree in psychobiology, and I enrolled.

As I pursued my studies, I liked the down-to-earth biological explanations of human psychological processes. How the human body works fascinated me, and I felt that biology is a more suitable life path for me to explore. After my bachelor's degree, I pursued a Ph.D. in biology in the Faculty of Medicine. And I felt that this is really the right place for me to be, and also, during the doctorate studies, I applied to a teaching assistant position. And I taught throughout the whole degree, and I loved it very, very much. I love to watch the "aha moments” in the student's eyes, and I felt they enjoy learning from me. And I could feel how to guide them in a way that would spark their curiosity. I really loved it.

Although I also liked doing biological research, it was clear to me that teaching is my main passion, and it comes to me much more naturally. And teaching about health and illness even more. Later, I was offered to teach nurse degrees also in several colleges. I accepted and became a lecturer. 

My Ph.D. thesis in epigenetics, it wasn't very clinically oriented. But in my teaching, I've worked with many different populations—the medical students, nurse students, and also there were secular students, and orthodox Jewish female students, all of them wanted to be relevant in their studies and have practical applications to their field of study.

I decided more and more to dedicate the time to an independent case study about the world of medicine and learning about clinical cases and dilemmas that the doctors face, and this is really fascinating field. This is not white and black, this is a very grey area, usually. And I love to facilitate the discovery of this work to students.

And I also have to say that my love for teaching has family roots. My dad is, among many other things, a professor, and he also was a school teacher for many years. Later in life, he taught in colleges. And I have been always impressed how his students loved him and kept in touch with him for many, many years after they finished school, even across the ocean, actually. So it was a big impression on me, too, and I think it inspired me.

Dr. Rishi Desai: That's fantastic. It sounds like you've had so many of those “aha moments” where you were able to watch your students light up and pass some sort of difficulty. I'm curious for you, especially with your father as a teacher, what was your experience like as a student? Like did you feel like you had teachers in your life that were mentors for you—other than your father of course—that helped guide your teaching style?

Dr. Masha Gouzman-Allouche: Oh, for sure there were several of them and I was happy to be their student, but I have to go back to my father, I think, and say thanks to him because he really was the one that showed me how to spark those "aha moments." I grew up in Soviet Russia, and my father became a high school teacher to avoid working with KGB actually because it was the way to run away...

Dr. Rishi Desai: Oh, wow. Quite a story.

Dr. Masha Gouzman-Allouche: Yeah, and it was really different reality compared to the one that I live with right now. The six of us lived in a small one-bedroom apartment. And I remember my dad was writing his doctoral dissertation about development in children, and he was doing it on a refrigerator in the kitchen because there was no place for a table. I saw his love for what he was doing, for teaching, and for learning about how to teach, and he put really all his soul in it. And officially, he taught physics, but I admired him the most for the summer camps that he was creating for his students. And during those vacations, they would travel from Moscow to a rural area, for one whole month, to experience the fieldwork and take part in different activities like sailing and skiing and nature exploration, and my family would join, also me.

And in these magnificent settings, I think my father taught the students about friendship, and leadership, and critical thinking, and curiosity about life, and this was very inspiring. And also, he ran a movie club where he taught how to watch and actually see movies and appreciate the art of it. As a little girl, I went to school with him, and also I traveled with him. And I saw how students learned from him, and the mark it left on me of a teacher who really cares about the students, and how they grow as a human being, and how they're really interested in knowing more and more. This was most powerful for me. And his passion for the subjects that he taught, it was really important to light the curiosity in them.

Dr. Rishi Desai: Just hearing you speak about your father, I'm getting chills, and I'm seeing your face light up. I mean, I just imagine his students light up as well. That person that cares so deeply is profoundly impactful in a person's life.

Dr. Masha Gouzman-Allouche: Yeah, for sure because later in life, when he was 70 five years ago, the students came for his birthday. 70 years old. Big date, and across the seas, from the United States, from Russia, they came to Israel and celebrated with him and for his birthday present, they gave him tickets for him and his mother to the United States to travel from coast to coast, in houses of his former students.

Dr. Rishi Desai: Oh, my God. Wow.

Dr. Masha Gouzman-Allouche: It was so... when you do something right, and then you get this feedback... your life was well done.

Dr. Rishi Desai: It also brings out the fact that you, as a teacher—you've been a professor of physiology, pharmacology, you're walking in big shoes, then, right? Like you've seen this greatness unfold in front of you, and now, you're walking your own path. I'm curious, what does that been like for you personally, knowing that you have this, maybe genetic, or a nurture component to your teaching as well. But you're charting your own path here as well. What has that been like for you?

Dr. Masha Gouzman-Allouche: Yes. He is a source of inspiration, but as you say, I tried to go on my own path and not as a high school teacher, but as a teacher in the university. And being a university teacher, it's different. Students are grown-up already. And in many cases, the classes are much larger. It's 200, 300, sometimes 500 students in that lecture hall. Until recently, the hands were tied, not being able to get to each student personally. And I think because of technology, things are changing right now. We can set lectures and I can set myself a little bit more free from those limitations and teach more student-centered, and deliver more active learning and transform, actually, our roles from being "sage on the stage" all the time to being, actually, "guide on the side" that we believe now is a better learning process for students.

So when I think of what I would like to put in my work and to be a good teacher, I believe that everyone needs to find what's in it for him. Some can be with a fantastic sense of humor and really helps engage students' attention and motivation. Some are really masters operating over an especially inclusive atmosphere in the class and some are great at storytelling. So for me, I chose, I think of the storytelling and being really caring about the students. It helps me to feel that I'm doing my job well.

I also try to know my audience—what they know, and what they don't know at the beginning, and how I can lead them to the point that I want them to be after the studying process, and to sense them on the way, and to put effort all the time in evolving as a teacher. Because there are a lot of new practices all around, and you can talk to so many wonderful teachers all over the world. Right now, it's even easier because Zoom is now so available, and you can just ask for someone for advice or to share his knowledge with you. A lot of times, it's a really interesting conversation. You learn a lot. Learning a lot and being curious myself, I think it's important for me as a teacher as well.

Dr. Rishi Desai: You know, with COVID, a lot of lectures have been given online, and you mentioned earlier that "aha moment" for students. I'm curious, has that changed in terms of like, how it is doing things remotely versus an in-person interaction for you?

Dr. Masha Gouzman-Allouche: Yes, I think it did. When COVID started and we all went online, I felt a big change for two of my hats. I actually have two hats in there, in faculty one as a lecturer, teaching students, and the other one is a promoter of teaching novel techniques in the faculty. So in the hat of a teacher that you asked, I felt that it was easy to go online because I already had experienced the blended courses before COVID. Actually, we develop them with my coworkers and colleagues from the department. Very innovative, I would say in that point of time. 

It was a big pharmacology course and it was based on the flipped classroom approach. And each unit inside this course, it had three different parts. The first part was interactive breathing. The second part would be watching videos that were also interactive, short, and very precise videos that lecturers made from the material that they would usually teach in front of the classroom in the lecture hall. But those now would be learned at home at a pace and time and place that a student chooses for himself. And later on, we would meet in class and during these meetings, we would ask students to be more active learners. Actually, they already have prepared at home and know some of the material, and in meetings, we would discuss with them different case studies, play games to encourage the active learning of what they already studied at home, and deepen the analysis of the things. And also, when COVID began, I felt that we only needed to find a solution for this part of the course to go online.

We found the turning of physical synchronous class a meeting into an online synchronous class meeting even had some advantages. This stems from the nature of our synchronous meetings. They were not classic lectures, but rather involved group work and active learning for games. So the transition to an online setting made the logistics much, much simpler. We did not need to schedule rooms. We could easily divide students into really small four-person groups in a breakout room, and this would allow collaboration and problem solving and contests we would encourage them to play in order to make it more fun.

But, of course, there were difficulties, much more about interpersonal enthusiasm that they can create when I'm there in the class. And I felt that I'm not so good at doing it online. It's really hard, much more difficult to get to students to screen. And also, you know, a lot of students had wanted to maintain their privacy and all. There was black screens in Zoom, and you don't see those eyes, those sparkling eyes that are so important to me, and you don't see those smiles from the other side that they understand, and it was really devastating for me. So I would always encourage them to open this part of them and to see some of the eyes that show how they are doing.

And also, I spent the last time in university and I felt the disconnection because there were fewer students in the university and I speak less with them and fewer familiar names and faces and everything was more technical and dry, really less human. And I feel that the learning experience, much like the teaching experience, was shallower and less powerful. When it was possible, most of us wanted to go back to the campus.

Dr. Rishi Desai: That's really interesting. And it's certainly I think there's something about being physically around other people that is also very invigorating and energizing, especially when you're learning something difficult, you know, like medicine. Yourself, you've often been attracted to technology and how technology can help improve education. On the flip side right now, we see a lot of focus on the negatives of social media, you know, other types of applications of technology like big tech and all that, not just around like privacy, but also like how it transforms people into basically just consumers, right, like just consuming content. What do you tell faculty that are averse to technology because of that side of it, and may not want to use technology in education? What sort of approach do you take with faculty like that?

Dr. Masha Gouzman-Allouche: Well, I usually show them what can be done, not forcing anyone, you know, just to show. And I also say that I believe that educational technology, it would be good—inevitably you can do bad and good, right? It can evolve to something that you don't expect. But in universities, when you use some technology inside the universities or colleges, usually there are a lot of eyes looking on it to decide if this technology is really the right solution. Also, from a privacy point of view, the companies must convey really guidelines. I feel much safer around educational technology inside the universities.

Also, I would say that, well, yes, some of the privacy is now less because they can see how students proceed and how well they are doing when they use the technology to answer questions, for example. But, on the other hand, this is something for letting them progress much better, maybe in a more personalized way. I like to show what there is to do with technology, and then let them decide what they believe more, and what they want to try, and what they decide not to use.

Dr. Rishi Desai: Yeah, that makes a lot of sense. And I'm also curious, then how stepping out, you know, we're also going through COVID, and that is accelerated a lot of the push towards using these technologies. What have you noticed in terms of other changes? I mean, you mentioned remote learning, people rushing back to the campus as soon as they could. Have there been any changes that you think are going to be long-standing—things that now that we're here, we're probably not going to go back to doing it that other way? Have you seen anything like that in your experience?

Dr. Masha Gouzman-Allouche: I felt that this global pandemic because all of us needed now to make a change, a really, really big change—there was no other choice. I thought that the global transformation opened lecturers' minds to use new tools for teaching. And I thought that was a unique momentum that everyone involved in teaching felt. COVID was a catalyst for processes of innovation. Suddenly, I felt that most of the lecturers want to at least hear what they can do new—at least try to understand what is there to see, and also the management part, at least at our faculty, it spent significant funds on technology—among them the Osmosis, purchasing also with the goal to create a new culture of teaching that enables more active learning.

And on the faculty level, the dean, the head of the school, presented a vision to the faculty, and presented the toolsets that were at the disposal of the lecturers. It seems that there is much more awareness and openness to innovative teaching today. And usually, you know, it takes many years for innovation to take its place in the world. There is this fear of innovations in society.

Dr. Rishi Desai: Yeah.

Dr. Masha Gouzman-Allouche: Of course, there are few people who are inventors and once there is a new technology available, there are those who embrace it. We play the early adopters, and then there is a need to recruit the early majority, otherwise it will not stay in this world. So I really hope that the early majority now is evolving and the teaching processes are changing in a bigger way.

Dr. Rishi Desai: You know, we're a teaching company and obviously, you're coming from a teaching family. We like to fill knowledge gaps. I'm curious, is there any topic that you'd like to educate us on that you think everyone ought to know? And it can be anything that you think is relevant.

Dr. Masha Gouzman-Allouche: Well, I was talking this week with one of my colleagues in the faculty, and she told me about the struggle she had. She told me that she really likes active learning, and she thinks it's really important to bring it to students. But then she tries to bring it to her class, and she gets feedback that it's actually a waste of time from the student's point of view. They like much better the classical lectures. 

She said, "What do I do? I feel like I put so much energy in it. It's not easy to create active learning, and then I get this feedback." And I told her that actually, she's in good company because there is an interesting article by Delray et al that shed some light on the situation. It's called the measuring actual learning versus the feeling of learning in response to being actively engaged in the classrooms.

In this work, they showed that their students perceive that they learn more from classic lectures compared to active learning when in fact the opposite was true. They divided the class into groups and they studied two topics in two different methods. One was active learning trying to solve problems in groups while the teacher was going from table to table and explaining, and only in the end, they would give them the solution and the explanation. And the second one was the didactic lecture, the classical one. And group A started the first topic actively, and the second passively, and vice versa.

At the end of class, they asked students to answer a survey. And in the survey, they were asked how much they felt they have learned from the class. And at the end, they took also a short test of the knowledge that would show how much they learned from the class. And the results show that students thought that they learned more from the lectures, but actually, they were doing better on tests after the active learning process. 

To explain these results, the article says there are several factors. The cognitive fluency of the lecturer that misleads the students to think they learn more—and this happens even more with the novice students—and so they are not very good judges of the learning process.

And also students a lot of times mistake a cognitive struggle that they have for an inferior learning process. When actually, it's a sign of an effective learning process. And they think in that article, it's very important to explain this situation to students before active learning classes so that it will increase their motivation and engagement in the actual active learning. And I hope this will help the students in our audience to appreciate active learning and the teachers in our audience not to give up on better teaching.

Dr. Rishi Desai: Wow. So that's a pretty huge point that you just brought up. If I can recap what I'm hearing, students thought that they had a better learning experience when they were learning passively. They said that, they reported that, but in fact, the opposite was true. And also you notice that discrepancy more with the naive learners, the younger learners, than with the more expert learners, the more senior learners. Is that accurate?

Dr. Masha Gouzman-Allouche: Well, the explanation why was that as a student, as a novice student, you have poorer metacognition about the process of your learning, and this is why it probably happens with the novice even more.

Dr. Rishi Desai: And the problem with that, the challenge with that is that now when we, let's say, we do surveys. We say, "Hey, how much did you learn?" And someone says, "Oh, I went from a 2 to a 6," or "I went from 1 to a 5." Well, if you're telling me that oftentimes people are not good judges of their own learning, right, then it really calls into question those kinds of results taken in isolation. Obviously, if there are other data points, and you can put together a story that may be more strong, but that soul sort of self-reflection, that self-evaluation may not always be reliable because like what you said, they actually may be scoring lower, the more useful parts, the more active learning. So that's interesting. Wow. That's a big deal.

Dr. Masha Gouzman-Allouche: A lot of time as teachers, we want to know what students think about our teaching, and it is important because there is a lot of things to learn from this criticism. And every time I finish the class, I read what they have to say, and I try to see how I can improve. But also you have to keep in mind that not everything that they feel is good for them is really good for them. So you have to explore for yourself the literature to see what is the better teaching ways.

Dr. Rishi Desai: That was fantastic. Let me ask you one final question, then. In terms of our audience, a lot of folks will look at your career and aspire to it or find it inspirational. What advice do you have for students out there that may be listening, early-career in health professionals that may be listening about how to approach their career in health care?

Dr. Masha Gouzman-Allouche: Well, I think that right now, one of the things that is hard for us to do while COVID is around is learning together. I think that distancing, a lack of human connection is one of the challenges for students, and they should be proactive to try to solve it, because universities don't always do it fast enough to solve this problem for them. Really try to organize learning groups, and get to know each other, and study in a collaborative way. It's important. And also another point that I want to address for those approaching the career in healthcare is that I think lifelong learning is really important.

I noticed sometimes an interesting transformation that happens to people, including myself actually, sometimes, that they put on a student hat, and many try to figure out how to get a good grade on an exam with minimum effort. This is the way for some reason some students.

I think, once they put on a teacher hat it switches. But in the student hat, it goes like that. But sometimes I do see students with light in their eyes and the curiosity, a natural one, that love to learn, and I think they're so lucky to have this already in the beginning and not later in life. 

I think once you embrace it, you become much happier through this period of study and also, of course, much better as a specialist in the future. I think one of the important things is to learn also about communication and compassion because, in this profession, I believe it will be the future, you know because there is artificial intelligence that's coming really strong in this field, and it will be helpful to every doctor really soon.

And I think that the niche that the doctors probably would have besides artificial intelligence is the niche of humanity and the warmth and the motivation for patients. Many processes will be different because of AI but this human thing, we need to put attention on it and learn it because I believe some of us maybe have it more from the beginning, but every one of us can learn it deeper and pay attention on this.

Dr. Rishi Desai: That's a phenomenal way to end it in terms of thinking first about empathy and compassion, and secondly, about the didactics, and then the concrete nuts and bolts of it because there's a quote that I like: "If they think that you care, then they'll care what you think."

Dr. Masha Gouzman-Allouche: That's a fantastic quote.

Dr. Rishi Desai: Yeah. And that's the key, like, you have to make people recognize that you care about them as human beings before they care about what you're trying to teach them. And so, I guess with that, I want to thank you. Thank you for joining us and talking us through your personal story, what drove you into teaching, and your philosophy. I think it's very inspirational.

Dr. Masha Gouzman-Allouche: Thank you so much. It was a real pleasure for me, too.

Dr. Rishi Desai: Well, I'm Rishi Desai. Thank you for checking out today's show. Remember to do your part to flatten the curve and raise the line. We're all in this together.