The Bang a Gong Teaching Style

So I was catching up with a friend the other day and he reminisced about how he learned consultation psychiatry. It was a revealing tale about the difference in teaching styles faculty have.

Before I tell you his story, let me remind you about my view of the general approaches. There’s the “scout” method in which the trainee, (either medical student or resident) sets off on a journey to wherever in the hospital the patient happens to be, interviews and conducts the mental status, hikes back to the office or (more often) pages the faculty to say, in effect, “I’m done,” and the faculty hauls over to the unit where the trainee delivers a more or less organized presentation of the history and mental status exam, followed by a formulation, assessment and treatment recommendation. This builds the trainee’s ability to act independently and develop his or her own interview style.

The other method is what I call “tag team,” in which the geezer faculty and trainees all round together as a movable feast and take turns interviewing the patient, repairing to the unit nurses’ station to debrief and give the faculty time to offer constructive and formative feedback on the trainee’s performance. The trainees get the advantage of role-modeling from the faculty–and get to see him embarrassed if he accidentally steps in it. I ignore the Hawthorne effect.

You can tell this is the style I prefer–and which the residents like.

There are important differences in the styles. The scout method takes longer and keeps you in the hospital until late into the evening. Often the patient tells a completely different story to the faculty than he gave to the trainee. The tag team method is more efficient, although with important limitations on the trainee’s development as an independent clinician. A mix of both is probably a good idea.

keep-calm-and-bang-a-gongAll good? Now let’s hear about another approach, which I’ll call the “Bang a Gong” style to teaching. I’m not going to mention any names because the principal is fairly well known in academic circles and if I were him, I wouldn’t want my name connected with this approach on blogs.

Anyway, this faculty’s style is similar to the scout method with a draconian variation. The trainee interviews the patient, returns to the faculty’s office and tries to present the case. I say “try” because the faculty has a method for driving his agenda home–by banging a gong very loudly each and every time the trainee misses an element in the presentation the faculty deems critical, be it in family or social history or whatever.

That’s not all. When the gong is banged, the hapless presenter then must get up and trek all the way back to re-interview the patient to pick up the missing element, then return to give a more complete performance.

How do you like it? Well, I don’t particularly care for the idea and find it sadistic. I don’t keep a gong in my office and if I did, I wouldn’t bang it to punish a trainee..but to reward competence or excellence.

Now for all I know, most trainees at the institution where this faculty teaches might believe he’s the best of the best of the best–SIR! But my friend took a dim view of it and so do I.

It’s a gimmick and makes for a good story. What’s my gimmick? I do a lot of walking and climbing the stairs all over the hospital–with the trainees. If you’re wondering about whether I’m making them do the same thing without regard for their joints, I always ask them if they need to take the elevators. I don’t consider myself sadistic.

PedometerOne of the residents suggested I get a pedometer so I could post how many steps I’m taking a day running all over the hospital. That could be my gimmick and it wouldn’t embarrass anyone…except me on a slow day.




Author: Jim Amos

Dr. James J. Amos is Clinical Professor of Psychiatry in the UI Carver College of Medicine at The University of Iowa in Iowa City, Iowa. Dr. Amos received a B. S. degree in Distributed Studies (Zoology, Chemistry, and Microbiology) in 1985 from Iowa State University and an M.D. from The University of Iowa in Iowa City, Iowa in 1992. He completed his psychiatry residency, including a year as Chief Resident, in 1996 at the Department of Psychiatry at The University of Iowa. He has co-edited a practical book about consultation psychiatry with Dr. Robert G. Robinson entitled Psychosomatic Medicine: An Introduction to Consultation-Liaison Psychiatry. As a clinician educator, among Dr. Amos’s most treasured achievements is the Leonard Tow Humanism in Medicine Award.

3 thoughts on “The Bang a Gong Teaching Style”

    1. Seriously, I could hardly believe it. It’s the same kind of sadism which drives the MOC program. Front-line docs recognize it at a visceral level–remembering. No one should wonder why we’re opposed to it.


  1. Agree with you Jim.

    I would think that you could list the missing elements in a scout-like presentation and check them all off once you get there. I don’t think people learn much (except resentment) from busy work.


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