Harvard Catalyst Profiles

For the past fifteen years, the focus of much of my clinical and administrative work, as well as my teaching and research has been respiratory physiology. Within this broad field, I have developed a particular interest and expertise in the area of the physiology and language of dyspnea. I have had the unique opportunity to integrate the three major facets of my professional academic life in such a way that each component offers insights that strengthen my capabilities in the other areas. By providing care for patients afflicted with respiratory discomfort, for example, I have gained knowledge that has led to the development and testing of research hypotheses that have broadened our understanding of the physiology of dyspnea, and of the interactions between chemoreceptors, upper airway, pulmonary and chest wall receptors in the generation and modulation of breathlessness. My research on the language of dyspnea, the terms used by patients to describe their breathing discomfort, has, in turn, made me a more astute clinician. Additionally, these clinical and research efforts have made me a far stronger teacher. In fulfilling my educational responsibilities, which range from directing the integrated human physiology course for first year medical students at Harvard to continuing education courses at the annual meetings of the American Thoracic Society, I am able to make the physiology “come alive,” to make it relevant based on my own experiences in the laboratory and at the bedside. It is immensely helpful when questioned by a student about ventilatory control, for example, to be able to say: “Yes, we studied that - what do you think the subjects did under these circumstances?” Because of the trend in recent years for biomedical research to become more focused on cellular biology, there has been a movement to segregate researchers from medical educators. For me, active work as a clinical investigator has been critical to enhancing my capabilities as a teacher and has allowed me to provide a model for students to consider as they contemplate their own career choices.

In the past several years, I have added a new dimension to my teaching activities. I chaired the committee that implemented a new curriculum at Harvard Medical School utilizing a new pedagogical strategy called Case Based Collaborative Learning (CBCL). This new curriculum focuses on the flipped classroom and an emphasis on collaborative approach to analytical reasoning based on inductive thinking from first principles of physiology, pathophysiology and anatomy. Our studies demonstrate that this leads to greater learning. Students are given explicit instruction on cognitive biases and the foundations of system I and system II thinking. We are also doing experimental work on the use of mechanism maps to evaluate student thinking skills.