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think outside the box

About the not so well known role of a good lecturer in the academy, to educate the trailblazers and not necessarily those who will follow the rut. A chapter from the book "Disclosure of heart" - the story of a heart surgeon, by Bernardo Vidana, together with Yaffe Shir-Raz, Focus Publishing, 2010

The cover of the book "Disclosure" by Prof. Bernardo and a discussion with Yaffe Shir-Raz. Focus Publishing 2010
The cover of the book "Disclosure" by Prof. Bernardo and a discussion with Yaffe Shir-Raz. Focus Publishing 2010

The book "Disclosure of Heart" published by Focus, written beautifully by Shir-Raz, is the story of heart surgeon Professor Bernardo Vidana, a senior cardiologist and winner of the Golden Hippocrates Award, considered the "Oscar" of cardiology. The book shares with the readers insights that Prof. Vidana came to from his life experiences and professional experience - insights into the qualities required to succeed and go as far as possible, not only in medicine but in any field.


To encourage the curiosity of my students, I used to announce the following sentence in my first class with them: "Know that of everything you learn here - 50 percent will be found to be wrong in the future and the remaining 50 percent will change in the coming years."

I know, this sentence is considered a "bombshell", especially for young students who are sure that what is written in the medical books and what their lecturer, a famous professor, explains to them, is in the sense of "seeing and sanctifying". But that's exactly why I dropped this bomb. I wanted to develop in my students the ability to doubt. Teach them to think outside the box.

Thinking outside the box is thinking that dares to question an existing and accepted concept, and to propose new ideas that do not align with the existing concept.

As a doctor, thinking outside the box has two sides: on the one hand, it causes concern. The world of medicine is characterized by a conservative approach, since caution is one of the important qualities necessary for a good doctor in treating his patients. Caution requires the use of tested tools that have proven themselves over and over again. On the other hand, without new ideas, a situation of "stepping in place" is created. In order to improve medical achievements, there is no escaping the development and implementation of innovative ideas.

The clinical doctor has three hats: the first one is his role as a therapist. The second and third - teacher and researcher. As a doctor, conservatism is the leading trait. However, in his other two roles, the doctor must develop and apply original thinking. As a teacher he must encourage his students to ask questions. As a researcher, his role is to try to soar in his thought to new realms. The more he is able to free himself from common conventions and concepts, the more likely he will arrive at new and original ideas. Most of the research doctors are not currently engaged in laboratory or theoretical research, but in so-called clinical research. These studies depend directly on the world of medicine and their goal is to test disease mechanisms, find new ways of healing and improve sustainability. The clinical researcher must therefore combine two polar worlds: on the one hand, the conservatism imposed on him as a doctor, and on the other hand, the courage required of a researcher. This combination is particularly difficult, even if there are many caveats, the main purpose of which is to protect the patient's well-being.

When I look back at my students, I realize that the questioners and doubters are the ones who managed to create uniqueness in different fields. Having a research activity is, in my opinion, a necessity for the thinking doctor, since this activity gives him tools for critical thinking and educates him to use scientific research methods.

I have a file on my computer with a humorous slide series that illuminates this topic so well that every time I look at it, I identify with it anew:

Slide #1: A young medical intern comes to his professor and tells him: "Listen, I have an idea for a new treatment." He enthusiastically tells him about the idea, but the distinguished professor is unimpressed. "Leave", he replies dismissively. "it will not work". It's chilling to think how many important ideas were rejected at this point.

Slide #2: After some time, the intern returns to the professor. "I conducted an experiment on dogs and the treatment was successful. I think there is something in it." The professor is still not impressed. "Look," he says with a hint of importance. "You know that an experiment on dogs does not exactly reflect the situation in humans."

Slide #3: The stubborn intern returns to his professor again, after successfully applying the treatment to one of the patients. "You know", he tells him. "I gave the treatment to the patient, and this time too he was successful." "You were very lucky," the professor cools his enthusiasm. "But I doubt if this patient really needed treatment."

Slide #4: The intern accumulates additional clinical successes in a number of patients, and again returns to his supervisor, who continues to remain indifferent. "Your treatment is very experimental", he replies. "It is too dangerous, immoral and technically impossible to implement."

Slide #5: The intern conducts a clinical trial, and returns to his supervisor with excellent results. "I conducted a study on 15 patients, and the experiment was successful," he informs his supervisor.
But the professor still refuses to be impressed. "Okay, so you were able to demonstrate that in 15 patients the treatment works, but these are carefully selected patients. Most patients with this problem do not need treatment in any case."

Slide #6: The intern does not give up. He persists in his research and this time expands it and conducts a controlled, double-blind clinical trial with a placebo arm, on a large group of participants. The research is successful, and he returns to his professor again. "It works!", he tells him with shining eyes. "The treatment I developed was successful."

"Fantastic", enthuses the professor. "This treatment is definitely a very important contribution to medicine. An excellent solution to a difficult problem. Oh well, I watched it. In fact, as early as 1929 I thought of this idea. Of course, we didn't publish anything then...".

The historian and philosopher of science Thomas Kuhn claims in his book "The structure of scientific revolutions", that science progresses not by way of accumulation, but by way of revolutions and reorganization. According to Kuhn, scientific education instills in students knowledge that the scientific community has accumulated so far - a paradigm. This fact creates a deep commitment to a certain world view and scientific work within this view. The commitment is a fundamental element of science, as it defines for the scientist the problems available for research and the nature of the acceptable solutions, but on the other hand, it limits his way of thinking to the same prevailing paradigm, thus blocking new ideas. Only when a crisis arises, and the old paradigm collapses, is a scientific revolution created - a breakthrough.

Research findings that are not explained by an existing paradigm create a need to develop a new theory, which has the power to also explain the new phenomena. When a theory is accepted by other researchers it becomes a new paradigm.

Even in the world of medicine, as in the rest of the scientific world, new ideas are accepted slowly, but unlike other fields of science, big revolutions are not created here. If we look at the way in which new paradigms were created in the field of medicine, we will find that these are small steps that led to small revolutions. The reason for this is that caution is so necessary in this world. However, it is important to guard against excessive caution that freezes creative thinking and prevents progress, since in order to develop good medicine, it is not enough to preserve the existing.

* * *

The good teacher has the ability to encourage breakthroughs in his students, and to never stop ideas or cancel them, even if they seem seemingly impractical and do not fit with existing knowledge. Even if the idea has failed in the past, a good teacher is one who strengthens the student and encourages him to persist in asking questions and exploring new ideas.

Give your students the blessing of the road and encourage them to go to new areas, because only young people with a sparkle in their eyes can break through. I have no doubt that that professor in the entertaining slide show had no intention of oppressing his student. The problem was that at his age and position, he already knew so much, he was too fixated to think about something new, completely different. We have to come to terms with the fact that at a certain age, after having acquired a lot of knowledge, we become bound by too many conventions. The really big ideas, the scientific breakthroughs, can come mainly when the mind is still free from these shackles.

To the book page on the Focus Publishing website

11 תגובות

  1. Adi (6) - nice and incredibly accurate - "It's a pity that the face of knowledge is in our day".

  2. to me
    I am a graduate of Shenkar College in industrial management, so the academic environment is no stranger to me,
    I also had good teachers, most of whom came from the industry, and knew how to convey these things to their students
    Later, I encountered this kind of behavior in the industry as well
    Good Day
    Sabdarmish Yehuda

  3. Entering the academy means entering a paradigm
    To get out of the academy and change is what requires thinking outside the box
    And it's not something acquired, it's a character trait.

  4. Another and no less respectable option,
    Speak and express your theory in your home field, in your language.
    For every place/site/country/field there is a language of terminology accepted for that place.
    Just like you can't talk about a scholar, who represents the academic left, the left is the symbol, Jewish.. :)

  5. With reference to the first comment published here, by Hazi (Shabi Mahek - well done, father!), it is fascinating to see that he identifies with that young and innovative intern, the rebel of the professor. But what would have happened if Hezi (H) had had the same conversation with the professor (P)?

    H: "Listen, I have an idea for a new treatment for heart failure"
    H: "The patient must stand on one leg and fold the other, eat ants and push a skewer into the right ear"
    P: "Why?!"
    H: "When he stands on one leg and the other is folded, the heart needs to raise less blood from low places, the ants he eats will enter the blood stream and carry oxygen more efficiently, and through the ear the skewer will reach the area of ​​the brain responsible for the operation of the heart, will damage it, and cause it to be rewired so that it operates the heart more efficiently (treatment based on the lobotomy principle)"
    P: "That's a really bad idea"
    H: "Why is the idea bad? Come try to contradict him"
    P: "Standing on one leg will not help, this is a very serious systemic failure. The ants cannot enter the bloodstream in their entirety, pushing a skewer into the ear will cause hearing loss in it, and the area responsible for the heart's action is also not there, and all it will cause is brain damage."
    H: …

    P. (waiting for the way out for H., but when nothing happens, turns to his thoughts, and after a while forgets that H. is in his office).
    H: "I have an idea for a new treatment for heart failure!"
    P (slightly startled and turns away from the computer): "What's the idea?"
    H: "The patient must stand on one leg and fold the other, eat ants and push a skewer into the right ear"
    P: "We already talked about it, I told you, it won't work"
    H: "You haven't contradicted anything in my idea yet"
    P: "Half an hour ago we talked and I contradicted all the elements of the idea!"
    H: "You haven't contradicted anything in my idea yet, any of the ideas can work"
    P: "There is not a single piece of evidence in the scientific world that supports that the process will bring any benefit to the patient, let alone harm"
    H: "It doesn't mean anything, any of the ideas can work"
    P: "Then prove it! Do a study, preferably in mice first, and come and show me"
    H: …

    P turns to his computer again. After a while, a patient with psoriasis (M) enters and sits down in front of P.
    P: "Hello..."
    H: "I have an idea for a new treatment for heart failure!!"
    M: "?! But I'm here for the psoriasis..."
    P: "Don't pay attention to him, his idea will never work, and I already showed him that"
    H: "You are an easy person. You never showed me anything like that."
    P: "H, you're an idiot"
    H (turning to M): "Please! Instead of discussing my idea he descends into personal attacks. This is the face of today's "medicine"
    H (turning to F): "You are simply jealous of those who are capable of creative thought! All you know how to do is what you were taught - bypass surgery and heart transplants, and as if that helps anyone!"
    P: "First of all, it helps a lot, and there is evidence for this from countless studies, and secondly, my team and I have been working on a number of new directions in the field for years and are investing a lot of work in..."
    H: "I have an idea for a new treatment for heart failure!!"

  6. Yehuda
    Perhaps the problem is not what the theory is but what it is supposed to contribute to the whole.
    As soon as someone realizes and attributes the idea only to himself and dismisses others, naturally they will not accept him because he is
    A rebel mainly includes his predecessors who laid the foundation for him - fundamental assumptions on which he lives or thinks.
    Or thinks he thinks..
    Sometimes there is no choice but to surrender

  7. Judah (3),

    Are you speaking from your extensive experience in the academic environment? As someone who knows the system from the inside, and being a witness to this despicable behavior of the lecturers?

  8. to Amitos
    Also be careful who you ask. You may encounter a lecturer who will get angry at your ideas and fail you because of it, or alternatively, steal your ideas.
    The lecturer must be an honest type with an open mind.
    You must check who the lecturer is and only then and carefully come up with your special ideas.
    If there is no such lecturer, wait for better days.
    You will find that it is much easier and simpler to fixate on the known paradigm and please the average lecturer.
    That's what it is.
    Good Day
    Sabdarmish Yehuda

  9. In general, older people tend to be less open to new ideas.
    There are differences, of course, like you, but this is a rather comprehensive personality aspect.

    I am an engineering student, Tabula Rasa, and I really connected with the article.
    And yet I wonder what I can take from it.
    How do you think as a student I should apply this approach?
    Like.. asking questions is cute and all, but quite naturally I will go and settle on the paradigm that I am taught.
    Am I supposed to avoid this somehow? What, looking to reinvent the wheel?

  10. The article is excellent and is true not only for the world of medicine.
    But I have one objection to what is being said.
    It saddens me that at the end he claims that actually older people (like me) shouldn't have innovation.
    My opinion is that the essence of the things said should be considered and not the age of the speakers.
    There are advantages specifically for adults who have developed a thick skin against all the disparaging reactions directed at them.
    Good night
    Sabdarmish Yehuda

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