As you prepare for the USMLE® exam, it’s important that your review instructors are experienced and knowledgeable in their subjects, with the ability to connect what you’ve learned in medical school to real-life clinical understanding. Becker’s faculty provides test-taking strategies for the USMLE® and ensures important connections between the exam subject matter and patient-centered skills and principles.
Get to know your USMLE® Step 1 Becker faculty: Philip Tisdall, MD!
Dr. Tisdall is an award-winning teacher and published author, trained at the Mayo Clinic, and is a diplomat of the American Board of Pathology (AP and CP). He is a dynamic and engaging speaker who helps students understand how to correlate the basic sciences and apply them to the essential thought processes of clinical medicine. In this interview, Dr. Tisdall addresses why he chose a career in medicine, his passion for preparing medical students to be the best doctors, and the future of medical education.
This interview has been edited for clarity and brevity.
How did you decide on a career in medicine?
When I was a young boy, I did not always use good judgement which led to several childhood visits to hospitals for trauma. No matter how hurt you were, when that medical team came around you felt better. I knew I wanted to do that.
So, you’ve always had this plan – even as a kid?
I started my plan to be a doctor when I was 9 years old.
Wow. Can you think of your most memorable experiences during your medical education?
I’m Canadian and they let a small number of people into medical school early. When I started medicine, I was only 19 years old and didn’t have a science degree. To a large extent, I became an adult through my years in medical school. I think one of my funniest memories involves autopsies, of all things! Going to an autopsy is an exceptionally good way to gain an understanding of how the body works. When I went to my first few real-life autopsies in first year, I threw up. By the 5th time, the autopsy team was all smiling in anticipation because they knew what would come next. [Laughs.] After the 6th time I stopped going!
Later, in my 4th year, I was talking about specialties with one of my very close friends. He said I’d make a great pathologist. I said to him, “Let me promise you what I will never be: a pathologist.” Not only did I end up being a pathologist, but I also ended up doing forensic autopsies as my hobby for many years. I reassure our students that they should not try to plan their futures too carefully.
How did you decide to transition from practicing medicine to teaching medicine?
I think there was a carrot and a stick that drove me out of practicing.
The carrot was my experience working with a group of high school students for a political club. It had no party affiliation, but it helped the students explore why they believe what they believe. When you can keep high school students more interested in meeting on a school night- with you than doing anything else, then you are doing something special! After seven years and more than one hundred students later, my wife suggested that I should be teaching. She gave me a “get out of jail free” card for good behavior and sent me to the Caribbean to teach for 3 years to see if teaching was the real deal for me. And it was. That was the carrot.
The stick was my fear of a malpractice suit. I practiced medicine for many years at an insanely good practice up in northern New England. Humans have an error rate and if you roll the dice long enough you’ll come up with snake eyes. We had one horrific malpractice case in our practice over the entire 35 years, and I recognized that I never wanted to go through that again.
What is one of the most memorable moments from your first three years teaching in the Caribbean?
The students loved my first course, but I overestimated what they could do. At the end of the first semester, I wrote too hard an exam and everyone failed. They were obviously very angry and I had to work through that with them.
I emailed my own kids about this catastrophe and one replied, “Your biggest worry now is that you wrote too hard of an exam for second year medical students? Life is good.” Talk about a welcome change of worries! I’ve learned that it takes years to know what a medical student can be expected to understand.
It was a great 3 years in the Caribbean but I needed to get back to my family. On my way back, it turned out that Becker was taking over the exam review for the school where I was teaching. I met with some of the Becker staff and faculty and they observed one of my lectures. 4 years later, here I am.
Now’s the opportunity to get back home and keep doing what you love!
And I love to teach!
Teaching in a medical school is a much different experience from teaching in a review, where you have to do all of the heart in just four hours. It’s an entirely new way of teaching and gives you a new command of your subject. It really makes you better.
What’s your favorite part of teaching?
I do two quality checks on my students when I’m teaching. On Day 1. I walk in the class and tell my students to place all of their Becker books, including mine, and put them on the shelves. They’re only reference books now because they’re about to become doctors, by which I mean that everything is now patient-based! This moment is painful for them because they’ve studied for two years and they can’t answer the simplest of my clinical questions. It’s a very difficult first morning, but I know it’s a necessary part of the clinical transition.
By Day 3, they get it. All of a sudden, it’s what they thought medical school would be! I know that my average student will go up 10-15% on their timed practice exam by Day 4 because they have learned to resort their data to be patient-based. Day 4 is always my first big reward.
When they email me after the exam I only ask them one question, “Did it feel like you were in class and I wrote the exam?” They always say yes! That quality check is my second reward. The good news is that I’m not special – I’m just like every other person in medicine. If we can do it, so can you.
Now let’s talk about some challenges… What are some of your least favorite parts?
As a teacher, you always have to differentiate between what I know because I practiced medicine and what the students are expected to know at the end of their second year. It is the latter that will be tested on the STEP 1 exam. That’s easily the hardest part of what I do.
When people are having trouble it tends to be one of two things: they either don’t read well or they have a bit of panic disorder. As soon as emotion comes into your exam, your brain is clouded. We practice a lot of multiple choice questions throughout the course and we talk about strategies for reading faster. And then, of course, I always teach with words and pictures. For example, when I’m teaching murmurs, I don’t just show a picture of it – I actually sound it out. I always teach students to not just see the words and pictures for murmurs, but to also say the sounds because that’s what you’ll do in real life.
Do your students find that your teaching in class is easy to translate to the exam, even when they have to read the questions?
Absolutely! Of course!
That’s why I’m better than them because I have the real sounds in my head, not just the words. The only difference between them and me is that I’ve been in medicine for 35 years and I’ve seen it all and done it all and so I have all of these mental pictures. That is what I show them in class.
I can gather than you have a rather unique teaching style.
How could that be unique? You mean everyone doesn’t teach like people learn?
But they should be!
I find it most astonishing that my teaching style is unique. Everyone else does, “okay class, let’s start the lecture. The uterus is a pear shaped object that measures…” That type of lecture is good for 12 minutes and then the brain floats away to what’s for lunch.
I’ll give you an example – when I do thyroid, I say “okay, if you came into my hospital on Thursday morning you’d see me walk into my thyroid clinic with a 1L bottle of Avian water and 20 dixie cups. Why?” That’s a fundamental deep understanding of thyroid embryology. Now, students who come to my classes walk out saying, “I can barely wait to go to thyroid clinic. I want to see this for myself!” You come to this point where well taught clinical understanding is built on a foundation of basic medical sciences. They’ve all loathed embryology until I teach them why they need to know – for direct patient care.
That is much more fun and memorable.
What currently interests you most in healthcare?
We’re currently in the century of information. There are 7 billion people in this world and only 1 billion has access to modern medicine, but all of them have access to information. How do we bring what we have to the 6 billion people who have nothing? The answer to this question is why I’m learning to teach.
If I can take what I know – which is how to build clinical medicine on a foundation of basic medical sciences – and put that on 30 iPads with an experienced clinician, I have a medical school. I want to learn how to teach so that I can go to any small town with my course and teach them how to be doctors in a very brief period. I’ve already proven that I can do that because I can go into a class and watch everyone go up 10-15% in 6 days.
It’s wonderful to send our clinicians to help one sick patient at a time, but the only way we’re truly going to help the 6 billion people without healthcare is to teach them what they need to know and let them teach themselves. This is my larger life purpose in teaching.
Do you think eventually you’ll travel around and teach?
Yes! The idea that these underserved people understand this revolution in information and that there is an easy way to bring it to them sounds important to me.
And it’s so possible!
If you walk by my house window this April, you will see me talking to my computer – I’m teaching India. I know that this can be done because I already do it.
Becker has an exceptional group of teachers for first and second year medical students. The best I’ve ever heard of! Imagine if all of us got together and put a curriculum together to help those without this information. Everything that I know in anatomy, Dr. Jack Wilson taught me. The tiny little bit of Immunology I can do, Dr. Mary Ruebush gave to me. I don’t know if you’ve ever seen Dr. Lionel Raymon do anything, but you have to see it to believe it! Dr. Carlo Raj’s grasp of Pathophysiology is probably unmatched, not just for its depth but its breadth. It’s quite a group! I really enjoy learning from them.
We all talk to one another and understand that transforming medical education must be the end goal. Right now our mission is STEP prep and it turns out that the best way to prepare for the exam is to prepare to be a doctor. It is intensely gratifying to be a small part of this.