“D” Way to Teach

Winter 2018
Photos: Courtesy Duker and Dunmire. Photo illustration: EGC/APK
Two Pitt Med favorites retired in June—Georgia Duker and Susan Dunmire. In her 31 years at Pitt Med, Duker (PhD ’82), an assistant professor in the Department of Cell Biology, won numerous awards, including two Golden Apple Awards, 17 Excellence in Education Awards, and the Chancellor’s Distinguished Teaching Award in 1999. Dunmire (MD ’85, Res ’88), a professor of emergency medicine, was honored with the Chancellor’s Distinguished Teaching Award in 2007. A Pitt Med prof for 30 years, Dunmire was a director of several courses and also served as executive director of the Medical Alumni Association. She has earned five Golden Apples and was named Clinical Educator of the Year in 2013. This fall, we connected Dunmire and Duker on a conference call to reflect on their careers and their friendship. 
What were the biggest lessons you learned over the course of your careers?
Georgia Duker: I had to get used to saying, “I don’t know.” And I would tell my students, “Don’t be afraid to say to your peers or to each other that you don’t know.” But I said, “Make sure you follow that up with, ‘I will find out.’” Whenever someone asked me a question either privately or in lecture, and I didn’t know the answer, I always made sure that I followed up. I wanted to get the students to see that there’s so much in the body of medical knowledge—you will never know it all. But know that you know how to find out the answers. That’s hard for medical students here. These are such top tier students; they’ve always had all the answers.
Susan Dunmire: I learned it had to be fun. That way, what you taught would stick. We really have a long way to go in the way we teach medicine. I don’t think we’re quite there yet. We’re getting there. 
GD: Yeah. Yeah, absolutely. I found that I needed to reread literature and rewrite my lectures. Every single year.
SD: A lot of my teaching was done in simulation. When I trained the people who were going to take over for me, I said, “The biggest thing you can do as you’re teaching is to watch them. If you start to see them look at a phone or zone out, you’ve lost them. Stop right there. Don’t keep babbling, because it’s a waste of your time and their time. You’ve lost them, so you need to back up and engage them again.” It happens so easily.
GD: I did the exact same thing, Sue.
In general, how did you structure courses to make it digestible, since there's so much material?
GD: When I became course director for digestion and nutrition in 2003, I laid out the lessons and said, "Okay, let's make this a logical progression,” so we started with the oral cavity. Then went on to the esophagus, stomach, small intestine, all three segments, colon, rectum, anus. We went through, and for each of those, we reviewed anatomy quickly. And then we did diseases of pharmacology. It all flowed the whole way down. The course, when I picked it up, was nothing like that. My biggest thing was this: Let's just look at the material from the perspective of what is the existing knowledge for the students and what is your endpoint so they have a good working knowledge to enter their third and fourth years.
SD: I probably completely redid my curriculum 10 times in 30 years. Towards the end, the biggest change I made was I had students come in and teach the course. The students really liked that a lot. A couple of days out of the month, we would have the students teach the other students. It was fantastic.
How did you get into your specific fields of medicine? 
GD: I initially wanted to be an MD. Did not get into medical school the first time around. It might have been because I did my undergraduate degree in two and a half years. When I was applying to medical school, I had just turned 19. I don’t think anyone took me seriously. So I did a master’s degree in a lab looking at changes in a tumor line. I decided that we don’t knowhow anything works normally. So when it came to getting a PhD, I was 100 percent focused on normal function. Over the years, I’ve taught in 12 different first- and second-year courses. Almost every single organ system. And my focus was always: How does it work normally? If you understand the foundations of normal, then the diseases start to make a lot more sense. 
SD: I was a drama major in college. I guess I went into medicine because I decided there was no way I was ever going to make a living as an actress. Medicine is the only other thing I ever knew. I’m the fifth generation of my family to go into medicine, and my son and daughter are the sixth generation. My father was a surgeon, so I thought I wanted to be a surgeon. But then I read about emergency medicine and thought it sounded cool. It was a brand new residency when I was in med school, so I tried it out, and it’s been an absolutely perfect fit for me. I’ve had so much fun. It fit my attention deficit disorder perfectly.  
Do you have a funny story about being colleagues?
SD: The worst thing she ever asked me to do was make gluten-free muffins for her class.
GD: I knew this story was going to come up. So one year in the GI course, every Tuesday morning at 8 a.m. we would do something totally different. One time, we had a hypnotherapist come in and talk about her study treating IBS patients with hypnosis. Another time, we had a yoga instructor come in. And then one Tuesday was healthy breakfast day. We had probiotic yogurt drinks, green tea, and I had asked Sue to make gluten-free muffins.
SD: And I can bake, but I had never baked gluten free before.
GD: She called me and said, “Do you know how awful this is?” She said, “My only option is rice flour, and it’s like sand.” But she did it. She came through. Sue, you remember what happened the next week then, don’t you?
SD: Oh yes, yes, yes, yes, yes, I do. 
GD: I had a real problem getting to sleep one night, and at 4 in the morning, I went to the ER with what ended up being a gallbladder attack. After a half hour with one doc, shift change occurred, and, lo and behold, Sue Dunmire was my new ER doc. At one point, just Sue and I were sitting in a dimmed room, and she leaned over to me, and she said, “You know what they’re going to find when they open you up?” She said, “Your gallbladder is going to be filled with this gritty sand because you made me bake gluten-free muffins.” It hurt so bad to laugh; and you just kept going on, Sue, and making me laugh and laugh.
SD: Yep, that’s me.
GD: That gallbladder was taken out by a second-year resident who was our former student.
When you look back and think of the students you taught, what sticks out?  
GD: They’re very altruistic.
SD: Exactly. They are doing this because they want to learn to take care of patients. And I love that. I love the enthusiasm. I think they are a complete joy to teach. 
GD: I still keep in contact with some of them. Last Christmas, I got a card from a graduate of the second year that I taught. He had failed the last course of his first year and had to remediate it over the summer. I chewed him out, told him there was no excuse; he got lazy. And he wrote, “You have no idea how many times I thought about that and realized that that was exactly it.” It feels good to have had an impact. It felt good to have students stop by my office. We must have gone to a dozen weddings of our students over the years. 
SD: I went to a conference with my husband. I happened to see five to 10 people who I’d trained. And just to have them come up to you and say, “Hey, tell me what’s going on in your life.” It’s very gratifying because a couple of them said, “I still remember what you taught me about this.” That made me feel good. And I’m happy I became friends with so many of the students. They knew that they could call me. Or I could pick their brains. And we could get through this together. It was a very gratifying career.