In most hospital settings "infectious" isn't considered a good thing. But when it comes to Vijay Daniels' contagious enthusiasm for teaching, it's just what the doctor ordered for medical students at the University of Alberta Hospital.
Daniels has been recognized as one of the top 10 post-secondary teachers in Canada, winning a 2022 3M National Teaching Fellowship Award for his work as a professor, assistant dean and clinical educator in the Faculty of Medicine & Dentistry.
Daniels is an internal medicine specialist and almost always has at least one learner in tow as he sees patients.
"If you come to the U of A Hospital with a medical condition such as pneumonia, confusion or multiple organs failing, you're likely admitted to internal medicine, and then you're taken care of by my team — medical students, residents and me as the attending physician," Daniels explains. "I'm simultaneously processing what the patient needs as well as what the learner needs. Of course, the patient always comes first."
Daniels' ability to find teachable moments on the fly and give students constructive feedback sets them up for maximum learning, says Cory Meeuwisse, a fellow in pediatric emergency who has benefited from Daniels' insight at various stages of his medical training.
"It's an environment where you don't have to fear making mistakes or not understanding or not knowing an answer to a question, because it's not focused on 'how much do you know?' It's focused on 'how much can we learn?'" explains Meeuwisse.
In the evidence-based field of medicine, that learning attitude is something doctors have to take with them right through their careers, according to Meeuwisse.
"If you ever stop learning, then it's probably the day that you should retire from medicine. That's the culture of medicine — there's always new things to learn and new things to discover."
Finding the 'aha' moment
Growing up in Winnipeg, Daniels always knew he would become a teacher because he loved tutoring friends who struggled in class. While doing his undergrad in biochemistry and math in Vancouver, Daniels was almost sidetracked by the lure of a career in rock music. But he got into medical school in Manitoba, and postgraduate training in internal medicine brought him to the U of A. He earned a master's in health professions education from the University of Illinois at Chicago along the way.
Teaching clinical medicine while caring for real patients in the hospital means that Daniels can't predict when teachable moments will present themselves, so he uses the creativity he learned as a musician every day.
"We don't control what patients may come into the hospital, so every day it's a different patient and a different learner," he says. "It's exciting that you're never really teaching the same thing twice — daunting, but exciting."
Daniels likens it to "calling an audible" in American football, when the quarterback makes a last-minute change to the game plan verbally at the line of scrimmage.
"I'll walk into a patient's room and think I'm going to be teaching on how to do a physical exam. Then I'll notice the daughter of my elderly patient's face is very clear — she's upset about something. I call an audible. I turn to the daughter and say, 'Hi, I'm Dr. Daniels. How are you feeling about the care your mother's receiving?'"
Instead of learning how to examine a knee, the students learn instead about how to talk to upset family members.
Daniels' greatest satisfaction comes when he can see the lightbulb go on in a student's eyes.
"When a learner hears a heart murmur for the first time — these are abstract concepts they hear in the classroom — but actually to be at a patient's bedside, they have their stethoscope on the chest and they don't think they hear anything," he explains. "And then I show them where the murmur is, and suddenly you can see in their eyes, 'I heard it!' It's actually training your brain to hear different sounds."
Individual learners need individual attention
Daniels starts the week for each of his practicum students with a question: What are your goals this week? Then he sets out to look for personalized learning opportunities for each of them.
He says personal attention from the teacher is key to success for doctors-to-be and for students of all ages. His own three children are in elementary and junior high, where individualized program plans, IPPs, used to be only for students who needed extra help.
"Honestly, every student has an IPP now, whether that's a kindergarten student or an adult learner in education, law or engineering," says Daniels, who has also been recognized for his teaching, leadership and innovation by the Association of Faculties of Medicine of Canada and the Canadian Society of Internal Medicine. He was named to Edmonton's Top 40 under 40 in 2018 and in 2019 was recognized with the McCalla Professorship at the U of A.
"All of these principles can absolutely apply at all levels of education," Daniels says.
It's all about the feedback
Medical students learn by doing during their clinical rotations, so constructive feedback is at the heart of Daniels' approach. Meeuwisse appreciates that.
"Sometimes I wish I could show up to work and totally relax because no one's going to be watching me through a microscope today, but that's just part of being a medical student," says Meeuwisse. "As uncomfortable as it is, that process allows you to grow as a clinician. And without it, I think there would be a lot of people practising subpar medicine."
Daniels says giving honest feedback to students is one of the hardest parts of his job. When giving a correction to a student, Daniels will identify the deficit and then immediately shift the focus to strategies for how to correct it the next time.
This is part of a conscious shift to an education model called "competency-based medical education." It means there is a checklist of skills aspiring doctors need to master — not just physical exams but more complex tasks such as leading a family conference or delivering a difficult diagnosis. The only way to achieve competency is to try the skill, get feedback from a teacher who observes you, reflect on the feedback, then try again and get more feedback — a virtuous loop of continuous improvement.
"One of the key principles of competency-based medical education is giving learners more autonomy to go after what they need, rather than following the old pattern of the teacher deciding what gets taught," Daniels says.
Turning assessment into a path forward
Of course, there's a test at the end, to determine whether you've learned enough to move to the next level. For med students, one of the most daunting is the Objective Structured Clinical Examination, or OSCE, where everyone is assessed on how well they face a series of standardized patient scenarios — delivering a cancer diagnosis, exploring a report of chest pain, examining a knee.
Daniels and a team of other clinical educators won the 2021-2022 David Cook award for making the OSCE assessment methods more transparent, including adding an electronic marking system that means students find out how they did within hours.
Even if students pass, Daniels explains, the assessment guides the students' next stage of development.
"They write a new learning plan, and when we follow up again in three months, we find it is actually predictive of changed behaviour in the clinical environment with real patients," Daniels says.
Practice makes perfect, although Daniels is quick to say he never suggests to students that he knows everything. He explains humbly that he will provide strategies to look up information he doesn't have top of mind.
Daniels feels a combination of excitement and apprehension as the new school term begins. There are 162 new medical students at the U of A this year, and he wants to be sure each one gets what they need to become a future doctor that he's proud to call a colleague.
He thinks back to a quote from Henry Ford, who said he could produce cars in any colour so long as it was black.
"It's so easy to make a simple machine that makes one product, but we're trying to develop diverse medical students to meet the needs of a diverse population."
