This issue’s vibrant essay in the Teaching Assistance column was written by Yinmon Htun, a Teaching Assistant (TA) at Kagawa University located in Shikoku. Having completed medical school and a two-year clinical internship in Myanmar, the author is currently in her final year of a doctorate course in the Department of Pediatrics. An afterword was provided by Takashi Kusaka, a professor at Kagawa University who advised Yinmon Htun to try a stint as a TA.
Ian Willey, a professor of English at Kagawa University who also observed a few of the TA’s lessons, empathized with her feelings about facing students. Noting that one’s natural speaking voice is often one’s writing voice, and that it can take time in the beginning to learn how to speak in front of others, Willey surmises (Personal Communication, 2019), “I would not be surprised if most teachers (and doctors) were to describe themselves as introverts, at least to some degree. I guess you have to be when you’re required to spend long hours studying.”
Since my final year of med school in Myanmar, I’ve always wanted to try something new. I wanted to get out of my comfort zone. Hence, I decided to do research in Japan, a country where I lived for a couple of years when I was little. Being able to communicate in the Japanese language was my advantage. In Myanmar, I prepared for studying in Japan by passing the Japanese language N1 examination, which helped me stand out in getting a scholarship—an important source of financial support when studying abroad.
I joined the Department of Pediatrics. The departmental members are dedicated to the better understanding of brain damage in newborns. When I first arrived in Kagawa, I was appointed to be a research student for six months. At that time, I didn’t have my own research project yet. Adding to my worries, my supervisor was absent because he was studying abroad. A professor, therefore, suggested that I try clinical observation at the Neonatal Intensive Care Unit, which could be useful in my future as a clinician and also for my current doctoral studies. Learning medical terms in the Japanese language was the greatest barrier I had to overcome (and I am still hitting that wall). Case conferences and ward rounds were extremely devastating because I didn’t understand a single word. However, my senior colleagues have been kind enough to be patient and understanding. They wanted to welcome me as a part of the team. Because of them, my clinical knowledge improved a lot.
During my first year of doctoral studies, my supervising professor suggested that I should try small group teaching with undergraduates in pediatric clinical rotation. At that time, I was trying to get accustomed to the new environment. I had numerous things to learn, and I also had a personal reason why I was terrified of this job offer.
Since this column is about teachers and teaching assistants, let me describe myself a bit more and share my beliefs. Most remarkable teachers are extremely outgoing. They have excellent verbal skills that draw the students in. On the other hand, I am extremely introverted. I am empathetic, but a bad speaker. My passion has always been writing. I am far from the image of a good teacher. I couldn’t imagine myself standing in front of people and talking for an hour!
On the other hand, I wanted to try teaching because I believed that teaching would help me improve my skills in Japanese medical terms. Also, I wanted to assist my colleagues. Eventually, I decided to take the job to teach 5th grade medical students who had just started clinical rotations. After discussions with my senior colleague, I came up with the most basic theme: Examination of healthy newborns. My lectures were to be conducted once every two weeks. The lectures would take about an hour.
Small group teaching, unlike teaching in a lecture hall, requires engagement with each student. In addition, we must be able to provide knowledge that is useful in clinical situations. However, these students were just out of the lecture-room stage, and had just started their fifth-year clinical rotations. The Neonatal Intensive Care Unit focuses mainly on how to resuscitate newborns. So, at the same time, TAs are responsible for smoothly transitioning students from bench to bedside. Therefore, lectures must be simple but not boring. To fulfill this, most clinical teachings in Japan use teaching aids such as dummies and simulators. Examination of healthy newborns is slightly different from resuscitation of the newborns. For resuscitation, dummies and simulators are excellent tools. They are specifically designed for common situations that we’d come across in daily practice. However, examination of healthy newborns involves analyzing facial features, skin changes, warmness of the skin, and so forth. At first, I used a dummy, but it was ineffective. This was probably due to the absence of features I mentioned above. I came to realize that choosing appropriate teaching tools is very important. Eventually, I decided to use plenty of pictures and videos.
When I started teaching, my lectures were probably boring. In the first few years, I struggled with teaching the class itself. I worried about whether the ice-breaking process would go smoothly. According to my supervisor, other than for freshmen, first encounters in the classroom with medical students often don’t go smoothly. I also felt some stress when trying my best to focus on how I should explain myself in the Japanese language. If my explanations in Japanese were to mislead the students, they might always remember that wrong information. Eventually, as an ice-breaking process, I tried to talk more about myself, and the current projects that I do. Research is a more familiar theme for me, which helped me feel confident enough to talk about it. After that, I’d listen to students introduce themselves and I would ask about their hobbies, what they’d planned for vacation, and so forth. I’d try to ask questions based on their brief talk. I tried to be attentive and immediately ask questions about what I didn’t understand. I put the importance of listening to the students; this is an advantage for introverts. By doing so, it was very interesting to learn about students because they all had diverse backgrounds and life goals which make them unique individuals. In that way, small group teaching helped me realize how important it is to listen to everyone.
After breaking the ice, we connected with each other by engaging with each other. Luckily, I am in my late 20s so my age is quite close to the students. This was also an advantage for students because they felt familiar enough with me to ask questions about anything (Figure 1). Some told me that they had visited my country! Another advantage that helped me is that I am from a different background with different experiences and do different research than other TAs. During the lecture, I could also tell students about the different clinical situations in our two countries and how doctors solve problems differently.
Most importantly, I tried to accept the fact that not every student was interested in pediatrics (Figure 2). Not everyone can be in the mood for attending lectures. At times, most students were sleepy. But sometimes the class was flooded with questions. In small group teaching, it is relatively easy to observe the individual condition of the students. If they are taking a lot of notes, I’m sure they are interested. Some might not take notes but do listen attentively. Some just fall asleep. Therefore, after a brief talk and a few minutes of teaching, I always decide quickly whether or not I should change my lesson plan by skipping some parts of the textbook, but still teach enough to emphasize important information (Figure 3). Lesson planning surely requires flexibility.
I am not regularly evaluated but sometimes, I receive good feedback for being succinct and informative. To be honest, I want some negative feedback too so that I can improve. Overall, I am quite happy about my class.
My teaching experience may somehow be different from that of the typical teaching assistant. I consider myself a kind of friendly study-mate. Perhaps I am the one who is getting the most out of the small group teaching classes. I’ve gained new knowledge through the clinical questions my students ask me. I’ve learned about cultural differences and individual differences from my students. That has led me to be more open-minded and patient. Small group teaching provided me with a good opportunity for self-evaluation and self-reflection. My class may not be the most captivating and entertaining one at my university, but there is a small joy in it. Accepting the challenge to teach has shown me how rewarding it can be to step outside my shell and share stories with people so we can motivate each other.
Takashi Kusaka, a medical professor at Kagawa University, shared the following advice to conclude this essay:
The best way to learn is teaching others. Learning is particularly important in research to find out one’s objectives; to figure out the methods that lead to results. I personally thought that it might be useful for Yinmon to have the opportunity to teach others to learn about her own research and eventually about herself. She is trying to fit into the role as a TA as much as she can. I believe that this experience will be helpful in her further studies and future career.