A Conversation with David Aron, MD
What is a physician doing as a faculty member in the DBA program?
It is odd or perhaps not odd at all, that the principles which underlie what I teach can explain, at least retrospectively, how I found myself in this position – contingency and the strength of weak ties. One day I agreed to take responsibility for teaching a course in the business school on systems thinking and complex systems. I would never have thought that I would have much to do with a business school. I don’t think that I have a single entrepreneurial bone in my body. My medical career has been in the public sector and not the private sector and I have always felt more comfortable in the former than in the latter. Nevertheless, when I was Associate Chief of Medical Service at the VA, the Chairman of the Department (Dr. Adel Mahmoud) arranged for the business school to put on a course for the division chiefs and other department leaders. The course included the basics of health care finance, marketing, and policy. In the language of social network analysis, this created a “weak tie” between my network of medical colleagues with whom I had strong ties and a network of business school faculty who had strong ties with each other but not me. It is through weak ties that more novel information flows to individuals through weak rather than strong ties; we are already familiar with what is known by our strong ties. From these interactions with business school faculty, in particular, Professor J.B. Silvers, collaborations developed. I became a member of the health systems management center which was primarily a business school endeavor and taught about quality and its improvement in the center’s educational offerings. From there it was a matter of calling upon another weak tie, a group of faculty interested in complexity from diverse departments – computer science, medicine and organizational behavior – where I met Richard Boyatzis. (How I got interested in complexity is another story of contingency and weak ties.) Richard was scheduled to teach with another member of the faculty the course on complex systems in the Doctor of Management (DM) program and asked me if I would co-teach with them. It sounded like fun, so I agreed. The third member of the group took a faculty position elsewhere. Then Richard asked me if I would be willing to teach the class on my own so that he could spend more time on his research. With some trepidation I agreed. The rest, as they say, is history. (Partially excerpted from his book: Complex Systems in Medicine – A Hedgehog’s Tale of Complexity in Clinical Practice, Research, Education, and Management, Springer Publ.)
What have been your challenges in teaching in the DBA program?
I have taught medical students for many years in a variety of venues from the lecture hall to small groups to ward rounds. Almost always, I am in the position of knowing considerably more about the topic than those I am teaching. Here at Weatherhead I start from a very different position. Here I am in a business school knowing little about business. In this area, every student knows far more than I do. My challenge is not in teaching complexity, but rather in ensuring that the students learn about complexity. The former doesn’t necessarily lead to the latter and my educational philosophy prioritizes the latter. This means that I have to connect what I teach to what my students already know, especially what is relevant to their “problems of practice,” a term with which I was not familiar when I started. There are huge gaps in my knowledge that I have to fill. I have had to learn about start-ups, entrepreneurship, leadership, corruption, project team function, and many others – a new bunch every year. There is a new vocabulary with each topic. That is the challenge, but it is also part of the enjoyment of teaching. I get to learn something with every class. I have to figure out how complex systems apply to their POPs. Every now and again a student carries out a project on a subject about which I know something, e.g., food deserts and the opioid epidemic, but even here, I have to figure out how complexity applies. This is one of the intellectual challenges. I also have to keep up on the rapidly evolving field of complex systems, but the biggest challenge is not teaching, but rather ensuring that students learn. The former does not inevitably lead to the latter.
So how do you ensure that students learn?
It is not that difficult to drone on in the front of the class oblivious to the students. I have had my share of teachers like that. Good teaching involves helping the students get engaged in their own learning. That is the essence of being a teacher. Several years ago, I found out that the CWRU medical school had a teaching oath created by members of the Teaching Academy at the school’s annual education retreat. Although I was not involved in drafting it, I have found that the oath expressed my longstanding teaching philosophy. The first statement is: “Find and express joy in teaching.” It is obvious when I teach that I am having fun. My style is conversational and I ad lib a great deal. I enjoy expressing my opinions so I begin with a PowerPoint slide stating the lecture is rated R, restricted – under 17 requires accompanying parent or adult guardian – noting that opining and sarcasm may “inadvertently '' seep in. Viewer discretion is advised, but feel free to challenge everything I say. I throw in jokes. I have been asked if I was a stand-up comic. It is fun for me, but it has to be fun for the students as well. I set that as one of the ground rules for the class. Next, is to respect learners as partners in the educational experience. How could it be otherwise? I learn at least as much from the students as they do from me. In fact, when I introduce myself, I say that I am a student just like them. I just happen to be in my 45th postgraduate year of training. I am a perpetual student. Next in the oath is to demonstrate humility through a continuous quest to improve my teaching and to always seek feedback from my students and others. For some reason, these are separate statements, but I am not sure that it is possible to separate the two. How better to demonstrate humility than to ask for help in improving, i.e., feedback? At the beginning of the class, I state: It is not important what I teach; it is important what you learn. Several times students have told me later that no one had ever said anything like that to them. At the end of a talk, I ask for feedback so that I can do better next time. Sometimes, I ask for feedback at the beginning and at the end. However, asking for feedback is of little use unless you take it seriously, even when it has been quite harsh, perhaps especially when it is harsh. And I got some pretty harsh feedback in my first couple of years in the program. I asked for volunteers to sit down with me and give me really detailed feedback and I listened. My teaching has gotten better each year. At least that is what my reviews say, but there is always room for improvement. There are other statements, but I think you have the general idea.
From your perspective, what is the importance or practical application of DBA training?
Although I have not gone through the program myself, my research career has involved mixed methods. Some might say mixed up methods. I did research in a laboratory for 15 years where I learned how to think like a basic scientist. Later in my career, I got a master’s degree in statistics and epidemiology so I have gotten a lot of what is in the course. I also did the equivalent of Richard Boyatzis’ course and have sat in on classes in other courses. This has had a practical impact on my practice which includes patient care, administration, research and teaching. Perhaps most fundamental is how I have become far more open to different ways of looking at the world. This is critical in the VUCA environment which we all inhabit. However, it is not just looking at things differently. It is also making connections between different fields and making use of the parallels. I guess I have become a transdisciplinarian in my old age.
How do you help experienced managers change their thinking and approach through empirical research?
In the medical profession, reliance on empirical research is at the core. We have come a long way since illness was considered an imbalance of the four humors. In addition, I completed my medical training before AIDS was described. In fact, I lived in San Francisco from 1978-1980 and I saw people who in retrospect clearly had AIDS. We just didn’t know it at the time. The progress in life expectancy for those with HIV is a direct result of empirical research. However, I have found that while what we term “basic research” can be interesting and it certainly expands our knowledge, I have always had a preference for what has been called Pasteur’s Quadrant. Research has been categorized across two dimensions – quest for understanding and fitness for use. Pure basic research as exemplified by Niels Bohr and nuclear physics seeks a fundamental understanding of nature – generalizable knowledge, while pure applied research as exemplified by the inventor Thomas Edison seeks to solve particular problems whether it be reproduction of sound (phonograph, a word coined by Edison) or provision of light (light bulb). Louis Pasteur combined the two in basic research inspired by use. I fit very comfortably in that quadrant. My current area of research is in implementation science – how to close the knowledge-action gap. I have also made use of the findings of implementation research in practice while trying to add new knowledge. This approach serves me well and providing examples in the class makes it real.
How would you sum up your experience as a teacher in the program?
That is simple. It has been fun. Hard work yes, but great fun. I have met many smart and interesting people who challenge me to grow. That includes faculty members too. I get new ideas and make connections. I am always learning, and I never know what I will learn next. When I teach a class I never know exactly what I will cover in a lecture. Even if I have distributed my slides in advance, I take cues from the students and change on the fly. I never know what is going to happen, but I am quite comfortable that whatever emerges will be good for the students and me as well. And I know that I will learn something in the process. I am a student. What could be better than that?
Dave has been teaching in the DBA/DM program for ten years. He is Director, Program Research and Education, Louis Stokes Cleveland VA Medical Center, Professor, Department of Medicine, School of Medicine, and Adjunct Professor, Organizational Behavior, Weatherhead School of Management. His recent book, Complex Systems in Medicine – A Hedgehog’s Tale of Complexity in Clinical Practice, Research, Education, and Management, is available at https://www.amazon.com/Complex-Systems-Medicine-Complexity-Management/dp/3030245926.
