Top teaching honour for celebrated surgeon

Not only does Professor Robert Dunn practise as a celebrated spinal surgeon, he heads up the University of Cape Town’s (UCT) Division of Orthopaedic Surgery, where he has pioneered innovative teaching practices at undergraduate, postgraduate and postdoctoral levels.

It is for this excellence in teaching that Dunn was selected for a Distinguished Teacher Award (DTA): the highest accolade afforded to exceptional teachers at UCT. Dunn spoke to Kate-Lyn Moore about his teaching journey.

You are already a celebrated surgeon. Is this your first accolade for teaching?

This is the first official UCT recognition of my teaching. However, since becoming HOD I [have] revitalised the orthopaedic undergraduate teaching programme, focusing on primary orthopaedic care rather than creating ‘mini specialists’.

We introduced the use of YouTube videos, which the students create themselves, instead of the old case reports. The best are uploaded to the UCTeach Ortho channel for the others to use. We changed the exams to OSCE (objective structured clinical examination) format, which was somewhat revolutionary in surgery. This resulted in a written congratulatory letter from (then) Dean Wim de Villiers.

I am part of AOSpine, an international spine education group, where I am recognised as an international teacher and educational advisor. The real accolade is seeing my juniors propel into practice – both orthopaedic and spine surgery – wherever they choose to settle.

What got you interested in orthopaedic surgery?

As a houseman, I witnessed the dramatic impact of Dr Meiring, the visiting orthopaedic surgeon, transforming bed-bound trauma patients to walking discharges with a few hours in theatre. It is a very positive discipline, not only enhancing quality of life – total hip replacements are only second to cataract surgery in terms of improved health status – but full of great, enthusiastic, ‘love for life’ people.

“The real accolade is seeing my juniors propel into practice.”

What do you teach and to whom?

My passion is teaching postgraduates, both doctors in the process of specialising in orthopaedic surgery and, even more so, qualified orthopaedic and neurosurgeons who come and train in spine surgery.

This latter group is a one-on-one, externally funded fellowship where we work side by side every day for a year in the spine unit, transferring not only academic knowledge but equally important technical skills and surgical philosophies.

Be this as it may, I have come to realise the importance of undergraduate teaching, where musculoskeletal pathology is neglected at UCT. Twenty-nine per cent of GP consults are for musculoskeletal ailments, yet they receive four weeks orthopaedic surgery and two weeks rheumatology exposure in the whole MBChB!

This drove me to reorganise the undergraduate teaching at an appropriate level, changing the exam process to drive skills learning, which UCT graduates lack in comparison to those from other institutions.

What do you love most (and least) about working with students?

The postgraduates’ enthusiasm to learn and compete with the best, despite the challenges of our overburdened clinical environment.

Some of the undergraduates’ tardiness, lack of punctuality, and sense of entitlement, whose demands have recently been excessively entertained by UCT management.

What do you believe makes a good teacher?

Enjoying interacting with people, being able to perform surgery – not just talk about it, and “leading from the front, supporting from behind”.

“This DTA recognition highlights the value we as clinicians offer UCT and raises the profile of my orthopaedic department significantly.”

How would you describe your teaching style?

Most of my teaching is around a patient, whether it is in the clinic, theatre or in courses, which lends [itself] to practical skills transfer with appropriate application of knowledge. It is personalised, and emphasis is placed on ongoing mentorship, even once the students have qualified and moved on.

How has your relationship with your students, teaching style or subject matter changed over time?

I realise I am ageing as my registrars have gone from calling me “Rob” to “Prof”. I am more tolerant of their individualism, and [I] think more sensitive to their knowledge/skills deficiencies. I have instituted more practical labs so that the surgeons can gain confidence simulating surgery on cadavers.

What is the importance of this kind of recognition to teaching staff?

The clinical staff are under a tremendous workload due to a burgeoning population, failing medical infrastructure and increasing student numbers with a static staff complement.

Generally, our teaching contribution is unrecognised by the university as we are perceived to be focused on the clinical demands. We are frequently too busy with patient care to attend the numerous UCT meetings or even complete the various award applications.

This DTA recognition highlights the value we as clinicians offer UCT and raises the profile of my orthopaedic department significantly.

“My efforts to teach and train came from a desire to improve orthopaedic and, more specifically, spinal surgical care in the region.”

What do your academic responsibilities entail besides teaching and research?

I run the Division of Orthopaedic Surgery, which operates on just under 8 000 cases and sees 27 000-odd patients a year over three hospitals. I look after 11 full-time consultants, five part-time, 21 trainees and five fellows, and see that all the integrated allied medicine partners function.

I represent UCT as a director on the UCT Private Academic Hospital board in their collaboration with Netcare and the provincial health department. I head the spinal surgery unit, where I provide reconstructive spinal surgical care. My interest is in children with spinal deformity, including those paralysed by spinal tuberculosis.

If you hadn’t pursued a career in orthopaedic surgery, what might you have chosen as a career?

I was originally planning a Bachelor of Business Science degree with a view to corporate riches, but despite not doing biology in matric, I was convinced by my best friend that medicine would be fun. Having discovered orthopaedic surgery, [I realised] he was correct.

What do you like doing off duty?

There is no “off-duty” for a surgeon, with a never-ending flow of WhatsApp pictures and queries from staff. However, I enjoy running and gymming – having completed the Comrades Marathon three years in a row – crayfish diving, hunting, playing the guitar on occasion, and being with my girls.

Any other observations, anecdotes or comments you’d like to offer?

My efforts to teach and train came from a desire to improve orthopaedic and, more specifically, spinal surgical care in the region.

It heartens me to see my enthusiasm mirrored by my present and, even more so, past trainees who have gone on to develop their own training programmes, not only at SA hospitals, but [also] developing our discipline in other sub-Saharan countries such as Namibia, Kenya, Cameroon and Zimbabwe.

I hosted a dinner two weeks ago and invited the 21 spine surgeons I have trained. Seventeen managed to come and share our experiences. All are making a massive impact – on patients and their own junior trainees – the ultimate positive Ponzi scheme.