The Courage to Improvise

Veeraraghavan Iyer, MD
Department of Psychiatry
UMass Chan-Baystate Regional Campus

Veeraraghavan Iyer, MD, once relied on a familiar lecture, confident he could rebuild what he knew worked. When his slides vanished the day before a session, he was forced to face a deeper fear: without that structure, he questioned who he was as a teacher. What began as brief panic became a reflective turning point—reshaping how he viewed teaching, uncertainty, and The Courage to Improvise.

It’s a piece of cake to reconstruct a presentation—to reconstruct yourself—in real time... right? What nobody tells you is that you’re the one enduring the intense emotional labor while that ‘cake’ is in the oven. In the heat of the moment, uncertainty and doubt become the very ingredients you’re forced to fold into the batter, all while fearing your latest creation won't measure as high as the cake that came before.

This lesson came to me on an ordinary Wednesday morning.

I was scheduled to give a didactic to a new cohort of residents — bright, and slightly nervous, but enthusiastic to begin their journey into psychiatry. The lecture was one I had given many times before. I had refined it over the years: structured, evidence-based, full of clinical pearls that landed reliably. It was, if I am honest, one of my ‘safe’ lectures.

I opened my laptop a day before the session, intending to skim through the slides one last time.

The folder was empty.

I assumed this was a trivial technological error — perhaps I had opened the wrong drive. I checked again. Then again. I searched by file name. I restarted the computer. I opened my cloud storage, my email archives, and old USB backups. Each search yielded the same silent response: nothing.

First came a surge of panic.
The kind that is deeply physical —that threatens the usual rhythm of the heartbeat, the tightening in the throat, a sudden, cruel awareness of time moving too quickly. I remember thinking, with astonishing clarity, you have done this so many times before. How is this happening to you?

For years, I had told trainees to roll with resistance and to prepare for uncertainty. I had spoken eloquently about resilience, flexibility, and the inevitability of clinical surprises. Yet here I was, undone by my own lost slides.

My next instinct was avoidance. I briefly considered canceling the session and sending an apologetic email citing ‘Technical difficulties.’ I rationalized that the residents would understand. I told myself I could reschedule and rebuild the lecture properly.

But beneath these thoughts lay another emotion — one I recognized from supervising anxious trainees before their oral clinical skills evaluation.

Doubt.

Without my carefully curated slides, who was I as a teacher?
Would my knowledge hold together without bullet points and structured transitions?
Would my material still be good enough? Or at least as good as the ones I lost?

With a day left before the session, I opened a blank presentation file.

Humility did not hit me at that moment as it did in hindsight. The weight of that blinking cursor felt accusatory and judgmental in the same breath. I started typing headings I remembered from the original lecture. Then I stopped.

A quiet realization surfaced.

I did not actually want to recreate the old slides. I wanted to recreate the safety they represented.

And safety, I knew — both as a psychiatrist and as an educator — can become a prison in the guise of familiarity.

So, I did something I had never done before. Instead of rebuilding the lecture from memory, I began building it from experience. I added case vignettes that had moved me recently. I replaced dense data tables with questions I genuinely wanted the residents to wrestle with. I inserted pauses in the flow of the talk where discussion could emerge. The presentation came alive in the form of loosely woven structure with a conversational flow, like a story.

The new material was undoubtedly different. It lacked the polish of the original version. I imagined residents thinking the lecture was disorganized or insufficiently academic. I wondered whether my colleagues would hear about it later and conclude that I had “lost my edge.”

The anxiety was not merely about one lecture. It was about the silent, ongoing evaluations that define academic life. Annual reviews. Teaching feedback forms. Informal reputations whispered in hallways. The unspoken pressure to demonstrate innovation while simultaneously remaining dependable.

How much change is acceptable?
How much risk can a teacher take before being perceived as inadequate?

My calendar reminder grounded me back to reality.

I walked to the lecture room carrying a laptop that felt heavier than usual.

The residents were already seated — notebooks open, expressions attentive. I remember feeling acutely aware of my heartbeat as I connected the projector. For a fleeting second, I wished for the comforting familiarity of my old slides. I wished for certainty.

Then I began.

The first few minutes were awkward. I spoke too quickly. I clicked through slides that looked sparse compared to what I was used to. I noticed one resident frowning thoughtfully and I interpreted it as disappointment.

But then something unexpected happened.

A resident interrupted me with a question.
Another offered a clinical example from their inpatient rotation.
Soon, the room was no longer arranged around my performance but around a shared inquiry of the topic. The curious voices reverberated with Socratic questions that gave depth to the topic being discussed.

We lingered on topics I would previously have rushed through. We debated treatment approaches. We laughed at the messy realities of practice. At one point, a resident remarked that this was the first lecture in weeks that felt “like real psychiatry.”

I remember pausing internally at that moment.

Like real psychiatry.

By the end of the session, we had covered slightly less content than planned. Yet we had reached a deeper level of engagement than I had experienced in years of delivering the same polished talk.

I sat alone in the room afterward, looking at the unfamiliar slides still projected on the screen.

The anxiety that had accompanied me all morning slowly gave way to something quieter — a realization that losing my comfortable and comforting slides brought out a transformational improvisation within me I hadn’t known was possible. Not the kind of improvisation that is performative as demanded by institutional checklists, but a more authentic one.

My realization did not descend in a dramatic moment. It arrived as a gentle shift in perspective.

Periodic evaluations, curriculum revisions, and expectations to constantly update teaching material often feel like threats. They expose our insecurities. They force us to confront the possibility that what once worked may no longer suffice. We fear that change will diminish us.

Yet change does something else too.

It disrupts our attachment to the familiar.
It invites us to rediscover why we began teaching in the first place.

That morning taught me that change is inevitable. Slides will be lost. Technologies will fail. Evidence will evolve. Learners will ask questions we are not prepared for. In these moments, we can cling to the safety of replication — or we can allow ourselves to create anew.

The new material I built that day was not simply a replacement. It was an evolution, not merely in those slides, but in my way of thinking. It reminded me that excellence in education is not a static achievement but a dynamic process.

Since then, I still prepare my lectures carefully. I still value structure, clarity, and evidence. But I also leave deliberate spaces for spontaneity — for the possibility that something unexpected might emerge.

Occasionally, I even feel grateful for the day I lost those slides.

Because in losing them, I found a deeper understanding of what it means to teach — and to learn — again.