What did Dallasite George Dawson, 103, who joined the Centenarian Club on January 18, 1998, have in common with the venerable Spanish painter? Well, for one thing, they both lived in the 19th century – Goya died in the early part, 1828, and Mr. Dawson was born in the latter part, 1898. But more importantly, Mr. Dawson, perhaps unknowingly, epitomized Goya’s now famous painting of a stooped, old man whose kyphosis and arthritis are most obvious. Walking with the aid of two canes, the old man depicted below was another of Goya’s self-portraits. He entitled this one Aun Aprendo, which translates to "I am still learning." This was significant in that Goya painted this at age 80 while developing the then new technology of lithography – he numbered and signed these works. Thus, "I am still learning" has become a motto for productive aging and lifelong learning.(Read our piece about Lifelong Learners.)

You see, George Dawson -- grandson of a slave and born in a three-room log cabin in Marshall, Texas -- spent the first 98 years of his life learning all sorts of things, but could not read and write. Somehow, he got by. But in 1996, someone knocked on his door. It was a recruiter for the Adult Basic Education Program at the Lincoln Instructional Center associated with the Dallas County Adult Literacy Council. This man, who had signed his name with an "X" for almost a century, went to school. In short order, Mr. Dawson, showed a keen intellect by learning his ABCs and being able to sign his name. He can read, and still attends classes daily. Read this fascinating story by Larry Bingham and photo by Carolyn Bauman, both of the Fort-Worth Star-Telegram.

Mr. Carl Henry, Mr. Dawson’s teacher, in Dallas, and Mr. Dawson were our guests on April 7, 1998, when the HCOA celebrated its 10th Anniversary. In the audience were many other luminaries – Michael E. DeBakey, M.D., noted cardiovascular surgeon and medical statesman, who, at age 94, still serves Baylor College of Medicine as our Chancellor Emeritus and consults with patients around the world; Senator/Astronaut John Glenn, who at age 77 became the oldest person to circle the earth; and Mrs. Helen Thomas, Senior White House Correspondent, who has queried more presidents than any other journalist. But Mr. Dawson upstaged our speakers. And why not? He had the distinct possibility of living in three centuries – born in the 19th, had then lived 98% of the 20th, and hopefully would live well into the 21st. Mr. Dawson has not only made it, he has now published a book. That from a man who only learned to read a little over two years ago! So, he has become yet another of our teachers. Thus, I hope each person reading this piece can say, like Goya did at age 80 and Mr. George Dawson said until his death in July 2001, "I am still learning, still writing." Is this a great time to be alive or what?

Lifelong Learning

The title of this presentation was inspired from the work of art entitled "Aun aprendo," which translates "I am still learning," an inscription on a black chalk drawing of an aged man walking with the aid of two sticks by the famous Spanish painter Francisco de Goya (1746-1828) when he was 80 years old.

My objectives for each of you are 1) to be able to answer to this question: "What is the relevance of Goya's inscription to health care I teach and provide on my service?" and 2) to perceive yourselves as both lifelong learners and as teachers.

Why is this emphasis on lifelong learning important? In part, the answer lies in the elements of the "demographic timebomb" which are 1) one billion people worldwide in the year 2030; 2) each month = net increase of 1,000,000 people worldwide 60+ years of age now; 3) over 33 million older Americans now; and 4) by the year 2060, as many as 2,500,000 people in the US will be 100+ years of age vs. the fewer than 75,000 centenarians of today. The impending explosion of the demographic time bomb begs this question: "Who will take care of these people?" The answer is you and people that you teach will. The other reason we must be lifelong learners and teachers is simply that changes are inexorable in 1) the health status of the population, 2) research findings affecting clinical practice, and 3) such new educational technologies as those afforded by the World Wide Web.

As learners, each of us must continuously increase 1) our own funds of knowledge and 2) our teamwork skills. As teachers, regardless of clinical roles and titles, we must not only 1) teach students who will be future caregivers; but, as well, 2) teach our "student" colleagues; 3) teach the "student" patient; and 4) teach those "students" who are family members of your patients.

Pedagogy and andragogy are terms relating to the education of children and adults, respectively. Andragogy (Knowles, 1981) deals with the independent adult learner who has his or her own goals and is interested in learning for a specific task or problem. By contrast, geragogy (John, 1988) alerts us to the unique areas of teaching older people who are less independent and who may not necessarily have a set of goals in mind when they come into a learning situation, e.g., no big promotions, salary increases, or rewarding changes in their lives. Furthermore, acquiring information uses psychological energy to perform mental tasks; obviously, not every patient/learner can expend that energy.

Regarding teaching strategies, better teachers assume certain responsibilities: I refer to these as the L03 Model, e.g., better teachers 1) facilitate learning opportunities, 2) ensure that learning occurs; and 3) document learning outcomes. To improve presentational skills, if possible, use videotaped microteaching practice sessions and consider that the anatomy of a lecture reveals three components: the beginning, the middle, and the end, each with a structure and function unique to that particular component. The beginning is where one takes care of the social amenities of thanking the host/introducers, tells the audience why the topic is important or why it was chosen, and tells them what the main points of the presentation will be. The middle is simply the presentation of the main points. The end of the presentation also has three components: the first being a restatement of the main points and their relevance to the audience, the solicitation of questions, and a concluding statement ending with "thank you very much."

The other type of "presentation" health professionals frequently make is being the moderator of a meeting or conference. As the moderator, you are still a teacher; you just aren't the "main speaker" per se. You are the facilitator of learning. To perform this role well, do these things: 1) introduce the speaker with remarks about why the topic was chosen and its relevance to the group, i.e., the learners; 2) keep the speakers on time by telling them in advance that you will sit on the front row and get their eye with a sign on a piece of paper with the number "2" on it, indicating that they have only 2 more minutes; 3) in soliciting questions, always have one or two to pose yourself in case the audience does not have any -- often this will stimulate other questions; 4) in concluding the session, mention one or two of the speakers' main points to emphasize again the relevance of the topic to the group; then 5) thank the speakers and the audience and initiate the applause by clapping your hands. N.B. Spend a quick post-meeting minute reflecting on how you did and always observe other moderators to pick up additional skills.

Also, better teachers "hook " their students' interest by pragmatically using anything that works; e.g., the psychodrama employed by Mr. Keating, the new English teacher portrayed by the gifted actor Robin Williams in the 1989 Oscar-nominated film "Dead Poets Society," can work. Exhort your students, colleagues, and patients and their families to, as Mr. Keating did his English students, " carpe diem boys-- seize the day and make your lives extraordinary."

I hope that each of you will exhort your students, colleagues, and patients and their families to, as Mr. Keating did his English students, "carpe diem boys -- seize the day and make your lives extraordinary." I hope that when each of us is 80 years old, we can be like Goya and say, "Aun aprendo....I'm still learning, still teaching."

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