Never too young to teach:
Never too old to learn

BRONWYN CHESTER | Though delighted at being a prize-winner, Ruth Russell wasn't particularly interested in being interviewed. "I'm happy not to be very well known," says the voice on the line from the Montreal Children's Hospital where Russell has been a child psychiatrist for the past 14 years. But, given her quest to improve the quality and evaluation of teaching in psychiatry, not to mention the recognition of teaching in the field, the recent winner of the CAPP (Canadian Association of Professors of Psychiatry) award agreed to be interviewed.

"I like to have teaching valued," she said, noting that "there are many ways of rewarding research but not of teaching." Psychiatry professors from each of Canada's 16 medical faculties are nominated each year for the CAPP award.

Russell is the first woman and the first child psychiatrist to win the three-year-old award -- the creation of fellow McGill psychiatry professor Gilbert Pinard -- just as she is the first woman and child psychiatrist to hold the position of coordinator of post-graduate education in the Department of Psychiatry.

One of her accomplishments in teaching has been the development, with internal medicine professor David Dawson, of the second-year medicine course on interviewing. In 1984, Danny Frank, now director of out-patient psychiatry at the Jewish General Hospital, invited Russell to join in on the endeavour just as she was finishing her four-year residency in psychiatry.

"That was my major initiation into teaching," says Russell, recalling, with a laugh, the "millions" of papers she and Dawson had to mark every Christmas when the total of 160 students handed in their term essays.

Russell, married and the mother of two grown children, is also known for her work with the Family-Infant Observation teaching program. Over the past 13 years, she and "co-pioneer" Jacqueline Royer expanded the program, first brought to the Children's from England by Irwin Disher more than 20 years ago.

Residents, working in pairs, visit and observe "non-clinical" couples soon to have a new baby. The idea is for the psychiatrists-in-training to observe "how new families and babies get along." Borrowing from the participant-observer method of research in anthropology, the residents visit once every two weeks over a six-month period. The program was cited in 1992 by the American College of Psychiatrists for its "creativity and innovation in psychiatric education."

In a 1995 paper on the Family-Infant Observation teaching program, Russell and co-authors Royer and Michel Grignon maintained that "learning takes place through the acquisition of knowledge, skills and attitudes." In conversation, Russell elaborates, introducing "generativity," the term of psychoanalyst Eric Erikson, which means that people of any age may teach.

Russell cites the example of a child with a terminal illness who, in approaching her imminent death, may have big lessons to teach the adults caring for her.

"We are always teaching and learning," says Russell, who likes to quote from William Osler: "No man can teach who is not at the same time a student."

When Russell leads seminars, her goal is to help "construct new knowledge" from all the knowledge and experience brought by herself and the students. Taking grief in children as an example, Russell explains that she would ask the residents, first of all, what their understanding is of grief, mourning and bereavement, as well as using outside resources such as articles and videotapes.

Two necessary characteristics of the teacher in this sort of democratic learning are humility and courage. "You have to be comfortable with not knowing," says Russell. "And to know how to turn that into a learning experience with such suggestions as: 'Let's think about how we could find the answer to that.'"

And Russell is often happiest, it seems, when she seeks to find an answer in collaboration with her residents. In the early '90s, for instance, while on the accreditation team for Canadian post-graduate faculties of medicine, she saw the need to address the question of sexual harassment in medical schools.

In tandem with then-resident Dara Charney, who is now a research psychiatrist in the addictions unit at the Montreal General Hospital, Russell wrote "An Overview of Sexual Harassment," published in 1994 in The American Journal of Psychiatry. One of the authors' conclusions was that "psychiatrists who participate in undergraduate or postgraduate education are responsible, as members of a university community, for promoting a harassment-free environment that facilitates more effective learning." Charney, Russell and others went on to develop "Teaching on Gender Issues" guidelines for the Canadian Psychiatric Association.

It is one of Russell's teaching attributes to encourage residents to "make [their residency] a clinical experience as well as an academic experience," and she has co-authored papers with residents, making them the primary authors, the case with Charney. "I encourage residents to present at national and international meetings and I take great pleasure in working on something academically when the resident is the first author," says Russell.

Russell may be loath to become "well-known," but her department's chair and the man who nominated her for the CAPP award, Joel Paris, says it's already too late for that. "She's a famous teacher.

"She has a hands-on, womanly, maternal approach to education," he says, adding that Russell would meet individually, once per year, with each of the program's roughly 40 residents, during her eight years as post-graduate program director.

She also practices what Paris calls "quality control." In a formal way, what that means is that residents have the opportunity to evaluate, in writing, their instructors after each Tuesday morning's worth of "centralized teaching" (when psychiatry residents from all six teaching hospitals meet for seminars).

In an informal way, what that means in Russell's words is that "residents be attentive regarding their own education and that they give feedback."

"It works," says Paris. "We hear about it when someone isn't satisfied."

And he's glad about that because the quality and care involved in Russell's teaching is one element which gives McGill's psychiatric program a good reputation and attracts residents from across the country.