My Philosophy on teaching

My philosophy on teaching is straightforward. In summary, I believe that we all should teach and share knowledge. We should do this with vigour and enthusiasm and see it as an honour. How can we expect to learn and be taught by the leaders in the field worldwide and not share our knowledge with the others locals?  We are obligated to our piers, our younger colleagues who will become the next generation and our patients.

I also had the opportunity to travel and attend courses and visit surgeons overseas, and I accept the obligation to disseminate my knowledge. I believe it makes more economical, logistical and practical sense to host teaching courses on local soil and invite international experts to visit us rather than us visiting them.

Prof Ugo Fisch
Prof Ugo Fisch

Our responsibility as teachers

Leonardo De  Vinci once said: “Poor is the teacher whose student does not surpass him.” We should undertake the responsibility of teaching with vigour and enthusiasm. It is an honour to teach others.

Some of us elect to follow an academic career at a University where teaching is part of our job description. Those of us that do not have a full-time -time appointment at a University can still get involved with teaching. I am not employed full-time. Yet, I teach at many levels as part of a part-time attachment at a University, as a member of the SA ENT Society and as an interest group like the South African Cochlear Implant Group (SACIG). Some colleagues teach on medical companies’ behalf, and others simply on their own and for the love of it.

Each one of us has the opportunity to teach.

The challenges we face in South Africa

There are numerous teaching opportunities available all over the world. One of our challenges is the remoteness of our country and the distances we have to travel. Another is the cost, as it is not uncommon for courses to be costly and hosted in currencies much stronger than our own. If one then adds accommodation costs, visa costs, travelling time and the loss of income when away, it becomes clear that this is not the best answer for our situation in the long run.

For those privileged to attend overseas causes, it should be an honour to disseminate our newly acquired knowledge locally.

A more lucrative option is to host teaching courses locally and bring out expert teachers from abroad. This solution is precisely what I have been propagating all these years

My journey as a teacher

When I started as a young, newly qualified and inexperienced ENT surgeon, I dreamed of becoming great in what I do. I wanted to be acknowledged by my elders and respected by my peers. At first, I did not care about teaching others; it was all about me. Luckily this attitude of mine changed early on.

Looking back, I can say that I had the opportunity to learn from the best. Early on, I started attending international courses and workshops. I was fortunate to afford these due to a fund Dr Marcel Groenewald and I established by doing international contract research in allergy. Without this and her help, I would never have been able to afford these opportunities. Many colleagues might be in the financial position to fund these expensive learning opportunities, but many are not!

Isn’t the ethically correct way then not for those fortunate to attend these to share their knowledge? Some believe sharing their newly acquired skills and knowledge with others will jeopardise their practices, and the patient base does not hold water. This is a selfish belief.

If I look back can honestly say that I have learned more from my local teachers and mentors. I graduated under Prof Johannes Swart at the University of Pretoria, worked intimately with Prof Herman Hamersma and Dr Fritz van der Laan, and had the experience of seeing Prof Andre Claassen perform surgery. All of these South African surgeons! Prof Claassen taught me about cochlear implants and vestibular schwannoma surgery.

Since I qualified as an ENT specialist in 2001, I have been attached to the University of Pretoria, first in the Department of ENT and, lately, the Department of Speech-Language Pathology and Audiology. I am currently an extraordinary lecturer in the Department of ENT at the University of Stellenbosch.

Vestibular teaching

In 2011 I founded the biennial “Update in the Management of Patients with Vestibular Disorders” course, which I have now hosted three times. Before that, no vestibular teaching course was ever held in South Africa. I hosted the last course in Cape Town with Prof James Loock of the University of Stellenbosch. Since then, I have hosted, organised, and contributed to numerous vestibular masterclasses for universities, companies and the SA ENT society. The masterclasses typically teach the participants theory and practical techniques for examining patients with dizziness and balance problems.

 A vital component of these courses was the involvement of my dear friend, Prof Michael Strupp, a neurologist specialising in neuro-otology, neuro-ophthalmology and neuropsychiatry. I believe in a structured approach where the history that the patient supplies is a vital aspect of the management. Ask the right questions, and the diagnosis will reveal itself. Vestibular medicine is an exciting and evolving discipline.

Vestibular courses are well attended
Vestibular courses are well attended

Cochlear implantation

During my previous appointment at the University of Pretoria, I was fortunate to host the first annual cochlear implant surgical training course in the history of South Africa. In 2012 I founded the “Annual Cochlear Implant and Advanced Temporal Bone Dissection Course”. I have hosted this with my committee on four occasions. On each occasion, I invited internationally recognised cochlear implant surgeons as part of the faculty. These included Rolien Free (Netherlands), Erwin Offeciers (Belgium), Antje Aschendorf (Germany), Gerry O’ Donoghue and Shakeel Saeed (UK) and Peter Weber and Elizabeth Toh from the US.

In 2022 I lectured with Prof Wolf-Dieter Baumgartner (Austria) at the Electric Acoustic Stimulation (EAS) Structure& Hearing Preservation Surgical Worksho. This was the first course of its sort in South Africa and took training in cochlear implantation to a new level.

Cochlear implant surgery is not that difficult. Surgeons should know the specifics of the products they choose to work with. During the courses, novice surgeons can practice their basic skills in the dissection lab. It is primarily the insertion of the electrode that is intimidating. Experienced surgeons benefit by improving their techniques and updating themselves with the latest products.  Where we had a challenge in earlier days to obtain temporal bones from cadavers, we nowadays have access to artificial 3D-printed temporal bones. This makes things a bit easier.

A temporal bone dissection lab
A temporal bone dissection lab

Temporal bone surgery

There is a continuous flux of new developments and techniques. Whether one works with a microscope or endoscope (or, lately, exoscope), approaches pathology from the front or the back, or believes in the open or closed method does not matter. More importantly, one should be accustomed to a specific technique and then stick to it as far as possible. Chopping and changing between techniques is not good. In all surgical methods, there is a learning curve. I follow the surgical principles described by the late Prof Ugo Fisch and my mentor Dr Herman Hamersma.

In 2005 I arranged an otology training course and introduced Prof Thomas Linder from Switzerland to South Africa. Thomas trained under Prof Fisch and, later on, became a recognised authority figure in his own right. In collaboration with Professor Andre Claassen, Thomas and I founded the first annual temporal bone at the University of the Free State in Bloemfontein. Many ENT surgeons attended this course in the following years. Since that time, Prof Linder has become a good friend and is still involved in temporal bone and skull base courses in South Africa.

I am also privileged to be a faculty member and teach at the annual Cape Town Temporal Bone Course, the oldest temporal bone course in South Africa. Prof James Loock from the University of Stellenbosch, who founded it, was later joined by George Browning (Scotland) and Claude Laurent (Sweden). This year (2023), it will be hosted for an astonishing 22nd time! Some of my co-faculty members teach different techniques, and the content has evolved. The most important fact of all is that the basic anatomy of the temporal bone remains the same, and therefore whichever technique, approach or surgical philosophy a student follows, knowledge of the basic anatomy stays pivotal and can only be mastered in the temporal bone lab.

Demonstration surgery

Vestibular and skull base surgery

Vestibular and skull base surgery are subspecialties of ear-nose-and-throat surgery that are not taught in detail in South African Universities. In the US, vestibular surgery is conducted as part of the neuro-otology training, offered as a two-year sub-speciality and recognised as such. There are also courses with certification in skull base surgery provided worldwide. I was a recent faculty member with Prof Linder and Dr Gerrie Moolman of the Practical Approach in Microsurgery of the Anterior and lateral skull base, hosted by the University of Stellenbosch.

Vestibular and skull base surgery is a complex surgery and cannot be mastered through teaching courses alone.  At least one requires a fellowship of a year or more before embarking on this journey. It is even more important to work closely with an experienced mentor to master surgical techniques. I was fortunate to have worked closely with Dr H Hamersma for more than ten years before I was able to perform the surgery with confidence. It is a pity that there is no one in line I can teach. As once said by Tao Te Ching:  “When the student is ready, the teacher will appear.” Let’s see if this will happen.

The future

No one knows what the future holds in store for teaching. I can only assume that by 2050 things will look much different. It is uncertain to what extent artificial intelligence (AI) and algorithms will influence our role as teachers and change our teaching models. We may become redundant. Be it as it may, we should not see this as a threat or a mere process we do not have any control over. We should embrace change and stay part of the evolving process.

“It is not the strongest of the species that survives, nor the most intelligent that survives. It is the one that is most adaptable to change.” Charles Darwin (1809 – 1882)