Commentary on “An Officer of the 10th Battalion, Cameronians (Scottish Rifles) Leads the Way out of a Sap and Is Being Followed by the Party”

I, Christophe Bedos, teach person-centered care and public health in a Canadian dental faculty. To encourage my students to listen to their patients, understand their perspectives, and engage with them, I organize encounters with people from groups often considered socially disadvantaged. The students and our guests share an open dialogue about life, health, and illness. I also facilitate small-group sessions during which students read and analyze narratives from virtual patients; I invite the students to be curious and to freely discuss the patients’ social, professional, and family environments, which are fundamental considerations for person-centered clinicians. One of these virtual patients, Roger X, incidentally mentions in his narrative that his daughter, a university student interested in history, “studies the logs of Canadian soldiers who were in the trenches during the 1st World War,” information that, at first, may not seem of particular relevance. I thus have not expected this detail to be a central point of discussion; nonetheless, I have hoped that at least some dental students would address it. I have been surprised and even disappointed that none of the students—close to 400 over the years—has ever remarked upon soldiers’ logs. The photograph by Paul Popper, “An Officer of the 10th Battalion, Cameronians (Scottish Rifles) Leads the Way out of a Sap and Is Being Followed by the Party,” represents soldiers in a trench during World War I. These unfortunate young men crouch to avoid bullets and shells. Some have left the trench and run, exposed to fire and death. I have read logs, songs, and poems written by these soldiers. They express horror and powerlessness: Lines of grey, muttering faces, masked with fear, They leave their trenches, going over the top1 When I look at this photograph, my first thoughts go to my great-grandfather, who died on the Western Front in September 1915, and whose framed picture still hangs on a wall in my family home. But this picture also evokes the young men and women whom I have been teaching for the last 14 years: Like the unfortunate soldiers in Popper’s photograph, dental students bend, lower their heads, and proceed cautiously through the academic dental curriculum. Dental students fear us, their teachers. Afraid of saying something wrong and being rhetorically attacked by their instructors through ridicule or reprimand, they speak with extreme prudence during class and are reluctant to engage in open discussions. I see students entrenching themselves in silence so as to remain unnoticed, almost invisible to their teachers, whose role is precisely to help and nurture them. Why do students hide in trenches? We teachers have helped to dig these trenches. By positioning ourselves as experts and indisputable authorities, by using aggressive questioning techniques, we have starkly distanced ourselves from students. By asking them to memorize and apply without discussion the knowledge we provide, we have shuttered their curiosity and creativity. We have created a learning environment in which dental students’ fear of being humiliated and failing surpasses their desire to learn, understand, and reflect. Dental students also fear their patients. “Can we talk to patients?” a student once inquired of me in a soft, timid voice that betrayed her surprise and incredulity after I encouraged the class to discuss the life of a virtual patient. Following the example of their teachers, students are still entrenched in a biomedical model, in which they reduce people to organs and diseases. They put little focus on the human being and remain unconcerned with how illness is embedded in social, cultural, and economic environments. As a consequence, students do not perceive any usefulness in becoming vulnerable, leaving their trenches to undertake the difficult task of engaging with their patients by listening and talking to them. The gap separating dental students from their patients moreover mirrors the gap that we dental teachers have established with students. In December 1915, French, German, and British soldiers spontaneously left their trenches and fraternized with the enemy. During this Christmas truce, they peacefully engaged in conversations and celebrations. Frenchmen and Germans looked at each other, and saw that they were all men, no different from one another. They smiled, exchanged comments; hands reached out and grasped.… If only we spoke the same language!2 We, Christophe, Nareg, and Jean-Noël, believe now is the time for dental students, professors, and patients to fraternize. But for that, we professors will need to rethink the art of teaching as well as the art of healing, and we will need to promote important but sometimes-forgotten values: humility, humanism, and respect. Acknowledgments: The authors wish to thank Alissa Levine for her help revising this commentary. Christophe Bedos, DDS, PhD, Nareg Apelian, DMD, and Jean-Noel Vergnes, DDS, PhD

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