6 Pieces of Advice for Just-Starting Third Year Medical Students

Now that I know where I’m headed for residency and recently worked with some just-starting 3rd year medical students as a teaching assistant, I feel ready to offer a few practices that helped me through my 3rd and 4th years of medical school. Years 3-4 of medical school are clinical practice years and years 1-2 are academic years, so the transition between the 2nd and 3rd year is challenging for most students.

My survival tidbits aren’t profound, but survival isn’t that profound either.

In no particular order:

  1. Use a sunrise light alarm clock. You’ll be surprised how waking to light transforms even the grimmest before-sunrise wakeups.
  2. Have a pump-up song and listen to it as you arrive at the hospital each morning. Switch up the song as frequently (or infrequently) as needed to ensure it helps you put on your game face…every…single…time…you…enter…the…hospital.
  3. Work hard, do all your work and beyond, and then strive to leave if you aren’t needed. Of course, only leave if you’re done with your work and it won’t compromise your grade or learning. I call this practicing self-dismissal. You’ll have plenty of time to be in the hospital at all hours during residency and at least you’ll be meagerly paid then, so go home when you’re done during medical school.
  4. Fight for moments to eat if they aren’t given. Try to eat all the food groups, just like you teach your patients to do. I know eating properly seems impossible at times, but anemia and other diet doldrums will make learning harder.
  5. Periodically take a moment to remember why you went into medicine in the first place – it can be a literal moment. This is most important during those periods when you aren’t sure you will survive. You will survive and there’s a reason you went to medical school so try to remember it.
  6. During the busiest rotations you can’t sleep enough, see friends, exercise enough, and study… so pick the two most important ones each busy rotation. It doesn’t have to be the same two each rotation. Know that there are slower rotations where you can do all these things, but sometimes you simply can’t have it all.

That’s it. You got this.



I sat waiting for the surgeon I’d work with to arrive at the hospital. Being a medical student involves a lot of waiting. On the wall across from where I sat and next to my surgeon preceptor’s office was a wall of fame, of sorts, of surgeons gone by. The black-and-white photos caught my attention because every single surgeon depicted there was a white male. The irony was that most of the surgeons I would come to respect in the weeks to follow would fit neither or only one of the “white male” descriptors. The surgeon I was waiting for, for example, was neither white nor male. She would single-handedly show me what it meant to be an excellent surgeon.

The operating room is cold. The lights are stark. If you are helping with an operation you “scrub in” (which involves washing your hands in a special way and putting on sterile gloves and a sterile gown). Once scrubbed in, you maintain sterility the entire procedure which includes only touching sterile things and keeping your hands in front of you and between the level of your bellybutton and chest. Bathroom breaks and snack breaks aren’t an option for medical students in the operating room, so I tried my best to do those things before entering the room.

Once the patient is settled on the operating table, they’re put to sleep by anesthesia.  As soon as it’s confirmed that the patient is asleep, their eyelids are closed with tape to protect their eye structures and a tube is placed down their throat to help them breathe.

While the patient is asleep surgery unfolds. All surgeries are done with a team of people, the surgeon is only one member of that team, and the surgery is not successful without every team member. The patient is covered with drapes except for the area where the operation will occur. This is interesting because the humanness of the patient is lost. Their body becomes a workspace once the drapes are placed. It may sound disrespectful, but it isn’t. Rather, the drapes are meant to protect the sterile workspace and maintain patient modesty.

Surgeons are the artists of medicine. Much like carpenters and painters and jewelers and other craftspeople they make their living by using their hands. The difference, however, between surgeons’ hands and carpenters’ hands, for example, is stark. The surgeons’ hands are soft and their fingers nibble while the carpenters’ hands are rough and their fingers strong.

Surgery is all about feel and dexterity. Surgeons tie knots with thin thread to keep arteries from bleeding. They sew with curved needles using plyer-like instruments. During surgery, it’s the surgeon’s hands that impress. Their fingertips can feel the difference between disease and health in tissue. Their hands can somehow hold more tools than you thought possible.

Ask a surgeon about surgery and about the operating room and their eyes become bright. They smile. They draw pictures and use their hands to describe structures. They talk about the neat surgeries and bodies they’ve seen. They talk about how many operations they’ve done. Surgeons are like artists. They love their craft and exude a love for their studio (the operating room).

I would eventually join a surgery led by the surgeon I had waited for by the surgeon wall of fame. A resident and I were helping her. The resident was soon to finish and become an independent practitioner. The surgeon was busy operating; I was holding a camera (used to see inside the abdomen); and the resident was doing something else to help the surgeon. “People will not take you seriously because you are a small female,” the surgeon said to the resident. “Don’t be disheartened. Respect is earned.” The surgeon would go on to discuss the importance of appropriate financial compensation for your work and doing excellent work. I would hear this message about differences and respect several times during my surgery rotation. I would feel why multiple women ahead of me thought they needed to tell me and my colleagues this information. Yet, it wasn’t new information because I, like most others, didn’t make it through my 20s without learning how my different identities help and hinder me.

There are many things that you could die from if it wasn’t for surgeons. But, as lifesaving as surgery is, it is also fraught with risk. Your surgeon can kill you. Having life and death literally in one’s hands is not a light matter, and you see its weight on the shoulders of surgeons when you work with them. The riskiness of surgery is also why the road to becoming a surgeon is a long, hard one. It involves many years filled with unfortunately long workdays. Apart from a grueling training marathon, surgeons have high personal standards for their work. High standards coupled with hard training leave many surgeons with a robust ego.

Egos aren’t all bad. You want a confident, proud surgeon. This is because you want someone who is very good at what they do and who takes pride in their work to operate on you. However, egos can be detrimental too. Too much ego can lead to poor listening skills, lack of self-reflection, and a complete disrespect for others. High-quality surgeons are confident because they are good at their work and love it, proud because they save lives, and humble because they know they are human and will make mistakes. The best surgeons are not only confident, proud, and humble but also curious. Curiosity makes the best surgeons because they not only love operating but, also, dig to the bottom of their patients’ stories, investigate thoroughly any mistake or less-than-perfect outcome, and keep up on the latest research and recommendations in their field.

On our last day working together, the surgeon that made me understand surgery had time to sit with me in her office by the surgeon wall of fame. She gave me some advice and her philosophy on medicine. “It’s nice when patients appreciate your work. You saved their life. But, they don’t have to and that’s not why I do it. I like to help people,” she said. The conversation continued for a bit. “People talk about quality of life. I don’t think it’s fair to say that you don’t want to do surgery because of the quality of life. Quality of life is something you make. For example, right now I pick up lots of call [24-hour shifts]. I do it because I am well compensated but, also, because it is good experience. I like to help people… I like having the cases [surgeries]… But, I won’t pick up call forever. Right now, it makes sense… It’s all about tradeoffs. You can work less and then you make less money… You can set the terms of your work,” she said.

As I left the hospital after my last day working with her, I thought about the surgeon I’d worked with. She was a calm and patient teacher – something that is rare. She had saved many lives. She had seen the inside of the body many times. Her hands could tell the difference between a fat glob and a cancer by feel alone. I’d seen her talking to patients with a patience you don’t find in all surgeons. I’d seen her interacting with all levels of hospital personal with a respect and kindness that was genuine. I’d heard her talk through her clinical reasoning; it was thorough. I’d seen her do surgery; she excelled. She was exactly what I’d call an excellent surgeon. I would have no hesitation sending my patients or family to her because I knew she’d treat them well and operate with precision. She was the first surgeon to go on my mental surgeon wall of fame. After that first day waiting outside her office, I’d decided to construct my own wall of fame (for surgeons and other types of physicians) because the one I’d seen in the hospital was outdated.

Leader vs Boss

The many teams I work on (of varying sizes) throughout my shift in the emergency department have provided ample opportunity to experience different team leads. And, in recent weeks, I’ve been reminded of a lesson I once taught my Paraguayan students (I taught life skills classes to grades 7-12 as a Peace Corps volunteer in Paraguay for 2 years). The lesson was during our leadership unit and it was on the difference between a leader and a boss.


I started my class with the following image:

I defined the differing titles as follows:


A leader is someone who leads by example. They are skilled, trustworthy, and levelheaded. A leader is confidant with their abilities, but they are willing to change their tactic if any team member has a better idea. A leader gets their hands dirty. A leader reminds you of your strengths and approaches weaknesses as learning opportunities not permanent shortcomings. A leader is willing to have that hard conversation or make the decision no one else wants to make. A leader makes every team member feel like the project belongs to them, not just the leader.


A boss is someone who leads by giving orders. They think their way is the only way and expect others to follow them. A boss is an expert, but they are not someone you go to when you’re having a problem. A boss is the first to address a shortcoming or mistake and says little when a job is well done. A boss stands above the work, but tells you how you should complete each task. A boss makes all the decisions, but when something goes wrong blames it on the team. A boss expects you to pledge allegiance to their project.


It’s not the breadth of knowledge or the level of skill that distinguishes a leader from a boss. They are differentiated by how they approach their colleagues. When I was a teacher, I asked my students to reflect on which type of team lead they’d rather follow and they always picked the leader. I asked them, then, how they were going to be leaders rather than bosses.

“Listen and be kind,” they said.

We could all remember my students’ advice. For some it comes easily while others have to remind themselves to listen and be kind. However, as long as the end is reached, it’s okay if being a leader doesn’t come naturally at first.

When work is slow, the opportunities to dish out compliments are obvious and abundant. Amid the chaos of a high census (lots of tasks all at once) or when faced with a critical patient, it can be harder. Leaders always find a way to lift us. That’s why we follow them. When the going gets tough, leaders bring us together while bosses push us apart.

Choose to be a leader. Your team needs you.

Framing: Beautiful Microbe, Beautiful Molecule

Before I started down the health science path I studied communications. In communications, there’s an idea called “framing.” Framing is a theory that’s often applied to the media and how it shapes public opinion about certain topics. The concept is that how you talk about a specific topic (ex. healthcare)—such as the tone you use and the details you include (or leave out)—can shape other people’s perceptions of the topic.

I’ve noticed that several of my science professors use framing as a teaching tactic. And, despite knowing exactly what they’re doing, I still fall for it.

I’m currently studying microbiology and organic chemistry. There’s a lot of new information to learn and for organic chemistry there are a few new thinking skills I’ve been practicing—such as being able to think about molecules in 3D. It’s an interesting challenge to train your brain to be able to rotate different molecular structures using only your imagination. I’m lucky enough to find microbiology and organic chemistry fascinating, but still it’s hard work. That’s where the framing comes in.

My organic chemistry professor introduces particularly complex or tricky molecules as “beautiful molecules.” “This is a beauuuutiful molecule,” he’ll say. He’ll also start a new chapter by saying “This is an important chapter. This is very cool…let me tell you why.” And, somewhere in that explanation of how awesome the challenging topic is, he’ll make a few comments about needing to practice the skills he’s about to show us. “But I will teach you how to…” he will conclude.

My microbiology professor does the same thing. I always know when he’s preparing to introduce a particularly complex metabolism, process, or cycle used by bacteria because he’ll pull up a picture of a microbe and say “This beautiful microbe…”

Those are current examples, but my general chemistry professor did the same thing. His word for hard concepts to learn was “interesting” rather than “beautiful.”

So what’s going on with this inappropriate use of descriptive words? Framing. Why? Because it works. As absurd as it sounds, it’s way easier to fight with a beautiful molecule than a molecule that’s “annoying” or “difficult” or “challenging” from the very start. I don’t think microbes are necessarily beautiful, but I approach them with much more interest and forgiveness when they are presented to me as “beautiful” rather than “ugly” or “evil” or “bad.” And, when trying to complete long chemical equations, it is a lot easier to complete the “interesting” problem than it is the “hard”, “tricky”, or “terrible” problem.

What’s my long-winded point? Before I dove into science I heard that it was “hard” and “confusing” and “dry” and “boring” and many other potentially negative adjectives. Sometimes I completely agree. But, most of the time, I do think it’s amazingly interesting. I think we’d do a lot of young people thinking about their future (and older people looking for something new) a service if we framed science as something wonderful. Sure, there is plenty about it that’s hard, and even monotonous, but most of it (all of it maybe) is not beyond most people’s reach. We’ve just conditioned our population to think science is either too complicated for them or not something they’d find interesting by describing it as scary, trying, and a thing that only geeks and brilliant people do. It’s worth a frame-shift around science. Why? What better way to find answers to medical questions, renewable energy questions, etc. than having more people researching and exploring those topics?

Teaching Sex Ed

I never imagined myself teaching sex education before Paraguay. But since late August sex education, focusing on HIV prevention, has been the center of my work world. And, it is some of the most gratifying work I’ve done in my ever-elongating life. What I enjoy most is watching how my students giggle more knowingly rather than awkwardly and show greater confidence as we work through sexual health topics. During my first class, my students wouldn’t say words like “penis,” but now they can tell me exactly how and for what one uses a condom with only a slight smirk betraying underlying tension.

Just like in the States, many families and schools in Paraguay skim or entirely skip sex education because adults are embarrassed or don’t know how to discuss the topic with youth. As a result, “sex education” is learned through experiment. It’s not that experiment is entirely bad but when it comes to sex, experiment without some basic knowledge and protection can often lead to unwanted pregnancy and sexually transmitted disease.

Because I’m using a program that focuses on HIV prevention, I talk about condoms a lot. As you know, they are the only form of birth control that prevents pregnancy and STDs. Just like in the States, condoms are under utilized in Paraguay even though they are widely available and often free. You might ask, “Why?”

Unlike in the US where there is a poisonous link between condoms and religion in some circles, the officially Catholic country of Paraguay, for the most part, does not view condoms as a negative thing. Myths and mistaken beliefs about condoms are one reason many Paraguayan men are reluctant to use condoms. Myths like one can not feel pleasure during sex when using a condom. Another, and perhaps more important reason, is that many people, both genders, are too embarrassed to talk about sex or get information about how to protect themselves that they just go for it. It takes confidence to get a condom and then ask your partner to use it. And, that’s where I think sex education enters the picture.

Sex education is partly explaining how things work, like how to use a condom, and telling what resources are available, like the different forms of birth control. But, I think almost more importantly sex education is a time to clear the air and help young people become more comfortable talking about their bodies. I like to think that my students don’t only learn how to protect themselves from HIV, but also become self-advocates so that if faced with a partner who asks them to take a sexual risk they don’t like they can stand up for themselves. One can know about all forms of protection and the ins-and-outs of sex, but if one is too nervous to say what he or she wants in the moment it does no good.


The Sly English Teacher

Now I’m happy to teach English in my community, but I was against it in the beginning. I am acutely aware that there are many more pressing things for youth in my community to learn than English, from reading Spanish well to using a condom correctly. And, even if I were the best teacher in the world (very doubtful) my students could not master English studying just 1 or 2 hours a week. Language just doesn’t work that way. But, English lessons are one of the things people in my community want; and I’m here to serve them.

So, then, the question arose: If I have to teach English and my students aren’t attacking it with the tenacity necessary to become fluent, how can I most effectively use our time together? Some volunteers turn to games. Games are a good solution, but I struggled with them.

My solution came when I realized that I was looking at teaching English all wrong. My English classes aren’t about English. (But, I like to think they will give those kids who choose to pursue more English study later an advantage.) My English classes are about mentoring and sharing my culture. Defense: We also discuss English grammar and vocabulary.

How do I start the cultural sharing? Music. In my English class, we usually listen to a song in English, talk about what it means, and pronounce the words. Listening to music is a good language-learning activity, but that’s not actually why I do it. I try to pick songs for a reason. Half the time I just pick a song because I know my students will like it, but the other songs I choose because they have an interesting cultural message. “Dear Future Husband” by Meghan Trainor was a successful choice—the youth even like the song. Most of my students are young women. It was neat to talk about how women don’t have to fall into the stereotypical role of “the perfect wife” when they marry.

“Hard to Love” by Lee Bruce was a silly chance to talk about how we should say “thank you” to people when they do things for us. Most women in Paraguay are expected to clean and deal with food while men (not all!) sit and watch. I’ve seen young men get up from the table, leave their plate as a disaster for some woman to pick up, and not even say “thanks” for the meal (rage almost not repressed). I also used “Hard to Love” to talk briefly about the differences between how Christianity is practiced in Paraguay and the US.

As I get to know my students better, they feel more comfortable asking questions about the States or about my life. Sometimes the questions make me laugh: Is it true that people in the States wear their clothes once and then throw them out? Bit-by-bit I think they are forming a more realistic notion of the States, and at least they are opening their eyes to the idea that not all people do things the same way.

In the end, English class isn’t just a time to talk verbs and articles. It’s also a chance for my students to talk about life. It’s an open space that encourages learning.

Anatomy of an Average Classroom

Since coming to Paraguay I’ve done a lot of teaching. I passed 100 classes a while ago. Though 100 is a humble number for a professional teacher, it’s a huge feat for me, as someone who never thought I’d teach (officially) in a school. Trying to teach 32 8th graders—or 20 unruly 11th graders—has given me a new appreciation for my teachers from 1st through 12th grade. I do sincerely believe anyone who teaches 8th grade for more than a couple of years should be sainted.

I think I get better with every class I teach, but who am I to judge? However, I am certain of one thing: Classes have personalities just like people do. The personality of a class depends on the parts and their ratio. Here’s my summary of the average class’ anatomy.

  • Front Center: Type A’s. They want to help. They want to participate, and they help control the other students.

  • Front Side: Students that come off as type A’s, but on second glance are just good at hiding their distraction. They’re interest and will participate, but it’s easy to lose them.

  • Middle Center: Reserved, quiet types. They are probably paying attention, but it’s hard to know because they’re almost always too shy to participate.

  • Middle Side: Students that are quiet and slightly distracted—typical cell phone users. It’s questionable as to whether or not they are paying attention.

  • Back Corner: Rabble rousers. They talk over the teacher and their classmates. They run around the classroom. They throw things at each other. They will participate, but their participation comes at a high cost.

  • Back Center: Aggressively abstinent. They will not participate no matter what. They won’t speak in class. They won’t do individual work. They don’t contribute when there is group work.


Che kaigue,” means “I don’t have the motivation or energy to do anything.” Che kaigue is almost always an acceptable excuse in Paraguay, and it is neither positive or negative. This phrase has been on my mind lately.

The general idea of kaigue bothers me. Not in the context of culture or Paraguayans, but in my own life. I recently hit a roadblock in my Paraguayan life and felt devoid of the desire to continue working. I fell into the dangerous trap of wondering if what I’m doing is actually worth the effort, and questioned what exactly I’m doing with my life.

Now pondering purpose and meaning of life is beyond the scope of kaigue, but none-the-less they are connected in my mind. And they are connected by the simple question: Where does motivation come from?

As a volunteer my main purpose is to prompt others to act. I inspire my counterparts to work with me. I incentivize my students to listen and learn what I want to teach them. I motivate my community members to include me in their already full lives. I energize my friends and family back home to (emotionally) support me even though I’m thousands of miles away. I do so much cheerleading for others, I sometimes forget to cheer for myself.

Where does motivation come from? If the answer to that question were simple, public health would be easy as pie and teaching my students smooth sailing. But, it’s not easy. Worse, it’s just as hard to think about one’s own motivation as it is to think about motivating others.

I’ve taken some time to think about the origin of my desire to do things and then my ability to follow through with those desires. There is a distinction between the things I want to do and the things I actually do. There is an endless list of things I want to do, and a finite number of things I achieve. Why is there such a big discrepancy? Hint: While time is a limiting factor, it’s of little importance in this discussion.

You might have guessed: Motivation. For me to be motivated to do something I must have a strong, tangible reason for doing it or it won’t happen. I also need to feel like I am successful—even if it’s only a hope for future achievement. I will not actually do things if I don’t have a clear reason for doing them or a hope for success.

Let’s look an example of how I applied this understanding of my own motivation to banish kaigue from my life (mostly).

Since March I’ve been teaching 10 sections of life skills to grades 8 through 12. Life skills to me means doing activities that help my students identify their strengths and weakness, communicate well, take an active role in their communities, take charge of their lives by feeling good about who they are, understand their health, and understand how to navigate life challenges like relationships. Our first topic was abilities: What do my students know how to do? How can they galvanize their strengths? How can they learn new skills? What can they do with their abilities? My second topic was leadership: What is a leader? What do leaders do? How do my students’ personalities relate to their leadership styles? What can my students do as leaders to improve their communities? Looking to the future, I will discuss sexual health, and specifically HIV and STI prevention.

I think those topics are pretty flipping awesome and darn important. Don’t you? Well, try telling that to a bunch of adolescents—ha. The point is this. I believe down to my toes that the skills my students could gain from my classes could help them make their lives happier someday. So, I have a good reason for doing the work. Check.

So, why didn’t I want to go to class anymore? Because I didn’t feel like my classes were achieving their objectives. It’s disheartening to go to class after class and have something like 20-30 people ignore me. I found myself wondering, daily and often, if my students acted out because my classes sucked or for some other reason. Regardless, my classes always go better when I start them with a positive attitude and lots of energy. That’s why my growing kaigue-ness was detrimental to my work.

My solution to motivating myself again was to do some self cheering. Self cheering began with identifying what I have done well. I have achieved something with some of my classes. Those groups that are finishing up the last class about leadership are doing better work than they once did. My students are learning to think for themselves; at least they’ve stopped asking if they should copy things. I very much dislike classes based entirely on copying other people’s ideas, which is the most popular class format in my school. My students are starting to find self reflection easier. I know this because they are doing it with less hesitation. In the classes where most or all the students give me the time of day we, my students and I, are winning. They don’t know it but they are reaching my goals for them.

I’m not winning in all of my classes. Part two of self cheering was realizing that it’s okay to give up sometimes. That’s a new conclusion of mine. I hate, yes hate, not completing projects I start. And I hate not starting something I say I’m going to do. But, life is complex. Part of my process of re-energizing has been allowing myself to say goodbye to the groups of students who don’t want to work with me. Rather than beat myself up by the clear failure of some classes I’ve come to accept that I can not motivate everyone I want to work with to work with me. Further I won’t make people work with me, so if I can’t motivate them we are at an impasse. Clearly, the classes where fewer than half the students listen or do the work have something demotivating them. I haven’t managed to figure out what that is, but I don’t have to let that negative energy devalue all of my work and affect the classes that are going well. I now teach 7 classes of life skills. I struggled to keep all 10 afloat, and I lost 3 times out of 10…or, better, I won 7 out of 10.

The example of my life skills classes is one of many motivation explorations that have robbed my sleep and filled my mind these kaigue weeks. I did the same exercise of flushing out my motivations and influences with my English tutoring, studying for the GRE, exercising, planning for my future, and other projects. Today, I accept that kaigue is a feeling I’ll have from time to time, but I refuse to let it be my state of being.

Teachers’ Day

Traditional Paraguayan dance

Traditional Paraguayan dance.

In early May, Paraguay celebrates Teacher’s Day, and it’s no small thing. In fact, in an almost ironic way, schools have the day off. The school where I work also got the day before off—because we held a celebration for teachers. In the morning of the celebration, students performed skits, dances, and poems. The school recognized one teacher who retired last year after 30 years of teaching. Then, there was a lunch for all the teachers. We had cake, danced a little, and sang traditional Paraguayan songs.

When my school invited me to participate in the teacher’s lunch not as a special guest but as a teacher it hit me: I am a teacher. I never thought I’d be a teacher. There were brief moments in high school when teaching, the profession, crossed my mind. My Peace Corps projects have brought me back to high school (I teach grades 8-12 primarily). My days, in Paraguay, are filled with life skills classes, English tutoring, and sometimes helping with communications class (Yes, I am helping with Spanish homework even though my students make fun of me for my errors in Spanish when I speak. It stems from the fact that I’m good at literary analysis, and that’s a challenge for many in my community).

Even if my role as a teacher wasn’t formalized by my work in the school, I still think my main project in Paraguay would be teaching. Whether I mean to or not, I push the people I interact with in my community to expand. First, they have to put in a good effort to understand me—which is not just a lesson in active listening, but also clear communication. Second, and more profound, we have different cultures and understandings of the world, and together we are helping each other grow.

It is easy to forget or demean the importance of exposure to people different from yourself in the grand scheme of life and Peace Corps service. But, in the end, that’s the core of it. Peace Corps volunteers do a range of work that can be reported—lectures, classes, building things, camps—but in the end the only sure things that change are the volunteers and the people with whom they spend the most time in their community. I can’t summarize personal growth neatly in a report. But, many things that are worthwhile are hard to quantify—love, friendship, goodness, happiness, kindness, respect—that’s what makes life so damn exciting.

A Sure-Fire Way to Spur Education Reform

Stick everyone who could make education reform happen, who is blocking education reform, or who isn’t interested in improving education in a classroom with 30 or more eighth graders. It would make waves. Of course this idea came to me as I started teaching again this school year. I have two classes with more than 30 students, and one happens to be eighth grade.

I’ve been thinking a lot about learning environments recently, and specifically how learning is significantly imperiled by each additional student you add to a class after 15. In my experience, 15 students is a golden number. Fifteen students is just enough to create some diversity of opinion, but not so big that students can easily hide from participating.

Before I started teaching in Paraguay, I was aware of the class-size discussion. Student to teacher ratio was something my parents sometimes discussed. It was something I was told to look at when picking a university. A low ratio of students to faculty members was something I touted when I helped recruit for my college. But, now that I’ve taught myself, I have a better understanding of why it is important to keep a balance between teachers and students.

Here are some of the differences between my classes that have around 15 students and my classes of around 30 students:

Around 15 Students

Around 30 Students

We finished all the planned activities in the allotted time.

We finish about three-quarters of the planned activities and go over time.

Students listen to the directions and ask questions when the don’t understand.

Students chat in groups and don’t bother to say if they understood the directions or not.

There is time to talk to each student individually and answer their questions, offer encouragement, and provide feedback.

Time is spent trying to maintain a semi-focused work environment and only very disruptive students and students who approach the teacher get a fair allotment of the teacher’s attention.

There are a lot of elements that go into making an environment optimal for learning. There are a lot of factors that make a teacher effective or ineffective. But, the short and long of it is that if the structure of the classroom itself is set up to falter, even the greatest teachers and the most studious students are at a disadvantage. I’m not saying that all students who are part of a large class aren’t learning. I’m saying that they deserve better. Ensuring that classes are an optimal size shouldn’t be debated. It should be an integral part of education infrastructure no matter where a kid goes to school.