You’d want your physician to know medicine deeply, but the principles of real learning are the same at all levels. Don’t settle for fact accumulation. Learn to ask questions that challenge assumptions, including your own.

What follows is an approximate transcript of my interview with Dr. Joy Smith:

[00:04] Mike Gray: Learning is not mere fact accumulation. It is not a rite of passage to adulthood. Learning should change who you are and how you think about yourself and the world and the universe you live in. I call this season “Tales ofTransformation.” These are not tall tales, but stories from real people who've experienced transformational learning. Transformational learning involves a confrontation with reality. It confronts our assumptions, and asks us to justify what we previously assumed. The process may be uncomfortable, but it's the only path to real growth. Join me, Mike Gray, a biologist with 45 years of teaching experience in higher education. I've engaged over 10,000 students in transformational learning.

[01:00] Mike Gray: This season, we'll hear the stories of transformation from my former students. Some of them who are now well along in their careers.

[01:13] Mike Gray: We are joined today by Dr. Joy Smith. She is a student that I had years ago, and we have maintained contact. I actually knew Joy before she was born, but we won't get into that. I'm an old guy. Joy was a student in my class, and that will come up in our discussion today. The topic that we're dealing with this season really is what we call transformational learning. I didn't make that term up. Transformational learning. You can get kind of the idea that something significant about your thinking was changed, and it was changed because your assumptions weren't matching reality. Well, at a typical point where this happens, the person involved experiences what we call a disorienting dilemma that also is kind of self-explanatory. You want out of dilemmas; you don't want to stay in them too long. And disorientation is not a feeling we relish either. So, the way out in transformational learning, out of this disorienting dilemma is through particularly evaluating your assumptions and finding where they're flawed or where you're mouthing things that you don't really understand. So, you need a deeper level of understanding, or you need a different set of assumptions. Joy's story actually goes back to her undergraduate years, but Joy is an MD. As well as a wife and mother of three. I think your oldest is eight, is that right?

[02:54] Joy Smith: Yes, that's right.

[02:55] Mike Gray: And your youngest is like one of my grandkids is five. And you’ve got a six year old, so you’re busy at home, but you manage also to get out of the home a couple of days a week and interact with medical students and residents and so forth. Your specialty is pediatrics, is that right?

[03:17] Joy Smith: Right. I trained in both internal medicine and pediatrics, so I do a mixture of both.

[03:23] Mike Gray: Well, welcome today and I’m interested in hearing your story of transformation. The process for you of going through disorientation by your reckoning, you say the clearest early example was in a course with me in your sophomore year, Essentials of Cell Biology. So why don't we talk about what was disorienting there and how you dealt with the disorientation.

[03:54] Joy Smith: Sure. Well, yes. Thanks for having me, Dr. Gray. It's interesting I have to note before getting into Essentials that God providentially prepared my mind through some earlier moments. I can recall a 7th grade Sunday school teacher who set me on a path to memorize scripture in bulk. And I think that was very shaping. And then a 10th to 11th grade math teacher who encouraged me to sink my teeth into a construct for seeing God's order in the world. So those were key elements, I think, that set the stage. My dad is a PhD in electrical engineering, so he encouraged our family through thinking and dialogue. So that too helped a lot. But it's funny, in my sophomore year in Essentials, like you said, my preconceived notion of classroom learning, quote unquote, was challenged. And the way it was challenged is this: the teacher wasn't primarily responsible for data transfer, which to me I think of lecture. And that's an individual standing up in front and imparting data and all the students dutifully taking notes, right? But no, actually that isn't at all what you are aiming for. Instead, you expected us to have already read that data, that content, before class started. Talk about a bit of a jarring reality check.

[05:23] Mike Gray: I might interject the reaction of some students when they encounter that is the teacher is not doing his job. I know how this education thing works. After all, I'm a sophomore in college and the way this is supposed to work, you are not fulfilling your job description. Yes, you're putting too much responsibility on me and not taking enough responsibility for yourself as a teacher.

[05:52] Joy Smith: Well, and of course, what's to follow is a far grander display of teaching. The teacher actually has a much larger task if this is the path that we're going to use. Which of course, as you know, is that you were ready for just about any sort of question-and-answer discussion surrounding the content that had been processed initially before class had started. And as you know, I would sometimes walk away from class wondering how you ever prepared for classroom discussions because we were all over the map. Did you ever wonder how to prepare?

[06:33] Mike Gray: Well, a student one time came by like the hour before Essentials, maybe 2 hours before, and saw me reading my Essentials book. And they said do you still need to read that? And I said, I need to know what you're reading so that I can clarify what I can expect of you and to refresh my own memory about the ideas and how they're communicated in the book so that we have this common base that we're operating from. The student was astounded that I still read the book, and I did every semester I taught.

[07:08] Joy Smith: Well, the neat thing is that with that preparatory reading and then with the expectation that we were coming in to discuss what we had read, it wasn't a waste of time. It wasn't like one or two students hijacked the discussion to some rabbit trail that left us all rolling our eyes. It was nonetheless very coherent in a narrative that you clearly had in your own head that you were actively seeking to impart to us. Is that really what you had going in your head that whole time?

[07:44] Mike Gray: Yeah. I won't give the backstory for Essentials, but that was work in progress for a number of years in coming to grips with what that course should look like and actually what that book should look like. I had a God-given opportunity to work with the publisher of the book in designing the pedagogy of the book. So, I would have to say I don't have a favorite course that I've ever taught, but that one was the one that I felt reflected my thinking, even in terms of what the student was preparing for class with the resources I was familiar with and had helped to evaluate and critique. So, there was something of being embedded in that process that made that particularly resonate with who I was and how I communicated. So definitely I had a narrative arc in mind.

[08:49] Joy Smith: The other piece that I'm aware of that was a bit disorienting is that this sort of discussion is not always neat and tidy when it comes to notetaking, for instance. So, the thought that I could come in and clearly define, oh, this is point A under heading number one, this is point B, it wasn't that choppy or say that defined. And yet, at the end of the day, we may have walked around a tree multiple times and we really got a sense of how wide the trunk was, how tall the tree was, what sort of leaves were on the tree, that sort of thing. And so, it was a bit of a disorienting dilemma, so to speak, to realize that notetaking in a class like that didn't have to be coerced into a very tight model, but instead may have looked more like a narrative, very much like what we were speaking out loud. Being okay with that was an important step too. Yeah.

[09:57] Mike Gray: And that's part of the disorientation, I think, for students besides me not doing my job, is the notion of what their role is, if they're a serious student, to be able to take structured notes. And it's really been my view that people who try and get down everything or are listening for the next thing to write down actually are not active participants in the discussion itself and are missing an opportunity to hear other people's thinking and to have their own thinking challenged and to participate fully in the discussion. That notetaking means you're deciding on the role of a spectator. Not that you never take notes, but that your task is more to be a full participant in the discussion and then at various points, to write down questions that you felt like were particularly helpful or undermined your sense of confidence that you understood, or summary statements about what we have arrived at that are satisfying. And I want to remember those, but not the stenographer essentially recording everything that happened in the class. So that's part of the disorientation. I know you encountered this when you were a sophomore, but you've kind of operationalized this, given that the course is called Essentials Cell Biology, or we've just been calling it Essentials. You have, I think, without me ever directly communicating, isolated the components that were built into that course to make it hopefully transformative to the majority of the students. And now you're using some of those principles both in homeschooling your three young children in classical home school and in teaching medical students and residents. So maybe you could talk about identifying, let's call them the essentials of Essentials.

[12:11] Joy Smith: Yes, I think that first component we've already touched upon the question-and-answer discussion of what I expect students or residents, medical students, to already have some introduction to is the first element again, the ability to have a discussion, assume some degree of knowledge in the topic. And so, I'll start, say, with my medical learners. In my office, I see both third- and fourth-year medical students who are really—they're naive to the full on care of patients. There's still a lot of lecturing and book learning for them. So, they're in one place. And then I have residents who have completed medical school and are very much in the deep end of caring for patients, et cetera. So, in both of those categories, in my clinical setting, I'm looking to ask them questions that can bring them to a point of conclusion about how to take care of a patient, to bring them to an idea of maybe another way of approaching a complex patient that they hadn't thought about yet. Instead of just spoon feeding to them. I'm actually hoping through question-and-answer discussion to help them come to that point. Oh, I see. Because I first have to learn where they're at, what info they already do have mastered in their head, and then use that to kind of spring off of. And it's challenging. Every learner is coming from a different place. But I find myself doing a lot of that sort of question-and-answer flow. Rather than just regurgitated data transfer, I will give articles, medical journal articles or other links to them and then say, hey, if they're at ground zero, they've never heard of something, then of course there's going to be some information transfer. But I may actually prod them to do the digging themselves on that information. One, just to help them see that they need to be a part of learning. And two, it'll stick a little bit better, I think, when they can do some digging themselves. With my young children, like you said, we are in the throes of a really fun journey of classical education from a Christian worldview. And so being so young, there is a lot of data transfer. They're sponges and I very unabashedly dump in a lot of information. They sing history songs. And part of that is just to get a lot of facts in their head, a history timeline. But then again, with this question answer discussion format, we ask why? Why did this very prominent leader, Julius Caesar cross the Rubicon? What does that represent? Or William the Conqueror in the Battle of Hastings. Why was that such an impacting moment for you know, I asked this question to them yesterday. So, these are young children who don't realize that these sorts of questions are not often asked at their ages. But why not? We're thinking, we're processing. So, I think your model has arced all the way out to where I am today and encouraged me that it is a reliable, appropriate way to approach education. And then just back to your question, what are those essentials of Essentials, I think, another point. In addition to the question-and-answer discussion, I find that learning in multiple passes is a very helpful framework back to my medical context. I may perceive that a learner does not really grasp some of the important nuances of a treatment plan or a disease process. But especially for those medical students who are still in the process of learning a lot of information, I am comforted that this is not going to be their first or second or probably even third pass on the information. I recognize that I'm just part of a whole process and I may intersect with that learner on an early pass. And so, I'll provide input where that learner is and trust that he or she will keep moving along. And then with my own children my third grader really disliked math last year, and this year it has clicked. But the neat thing was we didn't have to despair or panic when there wasn't full comprehension on that first pass. Maybe it didn't apply so much to her at the time. Maybe it was for me, it wasn't upsetting. Those initial bumps didn't need to be very discouraging to me because I recognized that we were running a mile, and we had another lap to go. We had another few laps to go. I remember talking about this with you when I was a student, and that was just really encouraging. So, I think that's another element. The multiple passes through. Do you call that whole-part-whole?

[17:51] Mike Gray: I actually learned that from a critical thinking authority back in the early ninety’s. And what he commented on was when we get down in the detail, sometimes we lose our place in the bigger picture. In a sense, you might lose your motivation. Like, I don't know what all these details are for. And so, we're back in the what instead of the so what. And so what is where I get my motivation for learning. Like, this is going to make sense. There's going to be a justification of some sort, but I constantly need to develop some depth and then connect it back with the bigger picture. So that's an intentional thing that I think the questions are the ideal way to drive because questions are not accepting as it’s just that way, but are looking for a justification of some sort or a connection of some sort that the student may or may not be in the process of making. It's been said that a lot of classrooms are boring because they're about data or information. They're trying to answer questions that nobody's asking. It's much better to answer the questions that are in people's minds that they would ask if they had the opportunity to ask if they felt like this was something that was in their best interest. So, you can ask questions with the disposition that you're going to try and make students feel dumb, or you can ask questions that they should be able to answer, but they're a step or two off in terms of the process of thinking from where most of them are at that point. And for them regularly to be able to answer the question in a way that satisfies them leaves them with something of lasting value because they have reasoned with what they have available to them to an answer rather than me just giving them the answer.

[20:12] Joy Smith: Right! Yeah. And quite honestly, as I think about this concept of multiple passes and various stages of learning, I'm encouraged even to think about my own heart before God and my own church community. None of us have reached perfection—full maturity. And I've recently been pondering this verse from Philippians three where Paul says, as many of you as are mature have this mindset, but if in anything you have a different mindset, God will reveal that also to you. Boy, that is just really encouraging. And it helps me that God too, is in the business of teaching us in stages. I need to yield to that. But I also can be encouraged and take heart that he is still, so to speak, running the laps. We're still moving around the track. And that's been a great model as I think about my own walk with God and the loved ones around me in my church.

[21:17] Mike Gray: And it's so true that we think we have a level of understanding of some spiritual truth or ways in which we ought to interact with brothers and sisters in Christ. And then we have some challenge to that that causes us to evaluate ourselves and to come to the conclusion, “maybe I don't understand that as well as I thought I did.” Because it doesn't seem that in this situation I can put this together with what I'm experiencing. Either the way other people are interacting with me or the way I'm reacting to their interactions with me, that I'm not as far along as I thought I was. That's the process of progressive sanctification that I grow in grace and in the knowledge of our Lord and Savior Jesus Christ. It is a growth process, not checking of some boxes.

[22:24] Joy Smith: Right. And that does remind me, too, of another. We can call them these essentials of Essentials, that model that Jesus himself demonstrates throughout the Gospels, where he is using questions and very probing questions to challenge assumptions and expose error, sin. I think of his encounter with the woman at the well, and it's really driven by a series of questions, and then she gets the idea and then throws a question back at him, and.

[23:01] Mike Gray: He takes the question seriously.

[23:03] Joy Smith: Yes. Right. And so, I love realizing that this idea of challenging assumptions and exposing a learner's misunderstandings or inappropriate thinking is actually Godlike. It's nothing short of being like Jesus. And I remember I've told you this, but I remember a conversation I had with you one afternoon after class. I still recall where we were standing in the lecture hall, and I think I said kind of incredulously, like, this is the way Jesus taught, isn't it? And you smiled at me and kind of slowly nodded. And it's like, yep, that's what I've been aiming for all along. And I think it's really motivating to realize that this sort of educational calling is no less kingdom advancing as sharing the gospel on a street corner downtown. And speaking of hardcore assumptions that are blasted away. I mean, full-time Christian service, quote, unquote, is really the life of every believer. It's a life offered as a living sacrifice. Whether we're teaching in a classroom, whether we're guiding our children to think about God's story and history, whether we're teaching residents in a clinic, it's all to reflect his own perfect teaching. And, boy, that really motivates me in the trenches.

[24:38] Mike Gray: I appreciate your taking your time out of a very busy schedule to touch base with me again and to share this story with our listeners. I appreciate it a great deal.

[24:51] Joy Smith: Thanks for the opportunity.

[24:57] Mike Gray: In the next episode, we'll hear about how transformational learning prepared Dr. Joy Smith's husband. Her husband, Dr. Nathan Smith, is a cardiothoracic surgeon whose surgical practice regularly confronts him with chaotic, high-risk patients. He credits transformational learning with giving him a clear path of response when he encounters unwelcome and potentially fatal surprises during surgery.

[25:28] Mike Gray: See you in two weeks.

For more insights into optimizing the learning process, I recommend my book, Unforgettable: Enabling Deep and Durable Learning. Short of diving into a book, the first two seasons of this blog start in a very basic way to explore what it means to know something. For those first two seasons the blog and podcasts episodes cover the same ideas, but in a different and complementary manner. Season four develops the dispositions I call “Learner’s Mind.”