Views & Reviews Personal View

Learning to teach

BMJ 2009; 339 doi: (Published 12 November 2009) Cite this as: BMJ 2009;339:b4554
  1. Philippa Jackson, core training year 2, Queen Elizabeth Hospital, Birmingham
  1. pcjackson{at}

    Allow me to set the scene. It’s your fifth week on the job as a junior doctor, and things are just starting to fall into place. Your head is above water; no one has died recently; all the blood forms are out for the day, so it won’t be another late phlebotomy round; and for once you’re not on take. Then, “Hi, I’m your new medical student.” The sinking feeling in the pit of your stomach returns. A medical student? Surely not. Surely the powers that be would recognise that you’re too green for this, too fresh, that you’re figuring things out for yourself and you can’t do it for someone else as well? But you check, and they’re right: they’re meant to be here. Their remit? To learn how to be a house officer. “That makes two of us,” you think.

    This scenario plays itself out all over the country at this time of year. The new term starts, and medical students at various levels are dispatched on placements with a variety of objectives, one of which is to learn how to do what you’re trying to learn how to do. Brilliant. Variations exist, of course: some students are heavily supervised by consultants and registrars, some don’t show up, and others are happy to sit quietly while you try to appear competent. The first time I tried to explain something in a medical setting to a student was one of the most frustrating experiences of my short educational career. We had a patient with hypercalcaemia, and he wanted to know why—why? How on earth should I know? All I knew was it needed sorting, relatively speedily. I referred him to the cheese and onion bible (Oxford Handbook of Clinical Medicine) and busied myself prescribing things. “Why are you giving her that? How does it work?” Oh, God. I wanted to reply: “The little fairies come and take all the bad calcium away,” but a shrug was the best I could manage, paired with: “It just does.”

    My point in telling this rather shameful story of education is that we are ill prepared. Nobody tells us that medical students will be coming. No one tells us what we should teach them, and certainly no one has ever told us how to teach them. Teaching is a skill that comes with practice and patience. Some people are naturals—quietly encouraging, helpfully explaining, using an armamentarium of methods to illustrate a point. And some of us pick it up as we go along, learning from mistakes we’ve made. Just the other day I was trying to extract some information from a new house officer; the problem wasn’t her lack of knowledge, it was my poor phrasing of the question. It was painful for both of us.

    Realising my inadequacy in this area, I have looked for ways to improve. I have researched courses, but these seem aimed at seniors undertaking more didactic teaching. I have canvassed the opinion of those around me, but they seem as unsure as I am. I have tried reading articles and books on the subject, but it is all so theoretical that it’s hard to see the practical application.

    And so the only option left is to use my experience. We will all have been exposed at medical school to a variety of teaching methods and styles: lectures, small group work, ritual humiliation, and so forth. And now that we are being asked to impart knowledge rather than accrue it, we must use these techniques ourselves (though less of the humiliation). We must learn to adapt to the situation we find ourselves faced with, be it huddled in the back of a crowded theatre or sat in the doctor’s office over a cup of tea. So now when the request comes on a quiet Tuesday afternoon—“Can you teach us something?”—my immediate reaction is not to cringe but rather to ask them, “What do you want to know?”

    And so this is my question: do we need to formalise learning how to teach within our medical education? Should ward based teaching be part of our foundation year programme? Or do we already know what we need in order to share our knowledge, however limited? All I know is that I enjoy teaching, and I find it educational, but from time to time I wish I knew how to get the best from people.


    Cite this as: BMJ 2009;339:b4554

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