Learner centred approaches in medical educationBMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7193.1280 (Published 08 May 1999) Cite this as: BMJ 1999;318:1280
All rapid responses
How and why did I decide to be a well trained medical practitioner?
Medical profession is a novel and pious profession in itself. Since time
immemorial physicians, surgeons and obstetricians are serving mankind to
relieve sufferings and pain. We respect successful medical practitioners
as angels among us.
A group of medical professionals choose to teach and train next generation
medical practitioners and build up well trained health care workforce.
In recent years it is noticed that there is a pedagogic shift from the
traditional teacher centred approach, in which the emphasis is on teachers
and what they teach, to a student centred approach, in which the emphasis
is on students and what they learn, requires a fundamental change in the
role of the educator from that of a didactic teacher to that of a
facilitator of learning.(1) Most of us looking for student cantered
training programme.(2,3) However, to inculcate such innovative programme
we need teachers to train new generation teachers.(4)
However, a group of medical professionals prefer to stay behind the
curtain and work continuously in the diagnostic laboratories, radiology
departments to support diagnostic services.
And last but not least to mention about other group of highly
motivated and dedicated medical professionals who compete with scientists
to develop new therapeutic techniques, drugs and many sophisticated
methods for diagnosis of diseases, treat them or prevent them.
Keeping all these vibrating future opportunities in mind, we often find
ample opportunities to look into this profession from different angles. My
father is posted as Senior Associate Dean and Professor in a Medical
College where mother is a lecturer in Pre-Medical Sciences. I completed my
Pre-Medical studies in the same Medical University recently and doing my
voluntary observer ship in family medicine clinic and a specialist
hospital for past one year. My maternal grandfather was a pathologist
while paternal grandfather was an anaesthesiologist and both of them
excelled in respective specialties.
I sincerely admire and adore medical professionals while I see them
diagnosing various critical diseases, and taking immediate decision to
relief acute pain and sufferings of the patients sustained motor vehicle
accidents or acute heart attack or analyzing a number of lab reports and
radiological findings of a number of chronically ill patients.
During my Pre-Medical studies, I gradually prepared myself to take up this
tremendous responsibility to train myself as budding physician leaving
behind natural inhibitions towards this profession. I could realize that
life in this profession is not at all a bed of roses. More I discuss with
my fellow colleagues, nursing staffs, medical technologists and operation
theatre staffs, I understand how hard they all work in a team to complete
their daily mission to give relief to their patients in urgent need.
I feel myself a fortunate child in the family of medical professionals
where I received all the necessary stimuli to activate my inner conscience
to be a responsible medical practitioner in near future. I hope it was pre
-destined for me.
Now I planned to follow the roadmap of the accelerated MD programme in an
affiliated US medical school and prepare myself for USMLE tests. I know
that there will be several hurdles to cross. But I am now determined to
achieve success in due course.
Concluding remark: Medical education is a lifelong process embracing
premedical experience, undergraduate education, general clinical training,
specialist or vocational training, subspecialty training, and continuing
medical education.(1) Therefore, we understand that we must be honest to
thyself before taking a life time decision and be ready to stand for it.
So, I did.
1.John A Spencer, Reg K Jordan: Education and debate: Learner centred
approaches in medical education:BMJ 1999 318:1280-1283
2.Stewart Petersen:Editorial:Time for evidence based medical education-
Tomorrow's doctors need informed educators not amateur tutors: BMJ 318 :
1223 (Published 8 May 1999)
3.Saroj Jayasinghe: Learner centred approaches in medical education: its
relevance in developing countries: BMJ (Published 9 June 1999)
4.Jogenananda Pramanik: Academic Medicine: Who is it for? We need teachers
to train teachers: BMJ ( published 10 Feb 2005 )
Competing interests: No competing interests
The article by Spencer and Jordan cover several areas of interest in
medical education 1. However, there are two areas of concern to medical
educators in the developing countries. Firstly, we often see "teacher
dominated approach" (extending from primary and secondary schools and
based on a culture of obedience to elders), which is an extreme form of
teacher centred approach, often characterized by showing little respect to
the basic human dignity of the learner. For example, the learners are
questioned in an intimidating manner, humiliated in front of peers by
laughing at "wrong answers" and shouted at (again in front of peers), for
not completing allocated tasks. This form of domination during teaching
activities (with the teacher controlling the ultimate weapon in the form
of conducting a subjective assessment such as a viva voce), breeds
obedience and dependency on the teacher for information that is
"politically right". Thereby,
creativity of the learner is thwarted and independent self-directed
learning is inhibited. Thus an initial step to foster self-directed
learning in developing countries should be to wean off this unhealthy
domination of learners by teachers. Staff development should highlight the
effects of these aspects in addition to educational methodology etc.
Secondly, there is a slow diffusion of innovations, often because the
teachers are ignorant or feel threatened with newer concepts in adult
learning, (especially if these methods encourage more control to the
learner!). Other explanations for slow diffusion include the strict
hierarchical organizational structures in the medical schools, which
inhibit innovations and responsiveness of organizations to newer
developments. Cultural factors, such as avoidance of uncertainty described
in Asian and
African countries, too are likely to play roles in inhibiting innovative
developments 2. Thus, for if the role of teachers is to change, we need to
consider organizational restructuring (from a rigid vertical structure to
a more networked horizontal structure responsive to innovations) and
evolution of culture (at least within the university system). These would
form the macro contextual factors, which should supplement staff
development at all levels.
Department of Clinical Medicine,
Faculty of Medicine,
1 Spencer JA, Jordan RK. Learner centred approaches in medical education.
BMJ 1999, 318, 1280-3.
2 Hofstede G. Cultures and Organizations, Software of the mind,
London, HarperCollins Publishers, 1994.
Competing interests: No competing interests