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 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.

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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.

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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