Doctors as teachersBMJ 2009; 338 doi: https://doi.org/10.1136/bmj.b1551 (Published 29 April 2009) Cite this as: BMJ 2009;338:b1551
Nevil Cheesman advocates doctors’ roles in teaching
As doctors we have a duty to teach, as highlighted by the General Medical Council’s guidance on teaching medical students.1 It includes aspects such as reducing factual overload; promoting questioning; self critical students; placing emphasis on knowledge, skills, and attitudes; and utilising teaching and learning strategies informed by educational theory and research findings.
This guidance implies that doctors should be knowledgeable in teaching methods and areas such as learning theories. However, it is unclear how many doctors have found the time or even the impetus to look at their ways of teaching. Medical students are not routinely taught how to teach, but after qualification they suddenly become aware that this is one of their responsibilities. This is highlighted by the fact that all applications for jobs have a section for experience as a teacher. Teaching is therefore a duty but also important in career development.
It is, however, the duty imposed and the feeling of necessity that can lead many doctors to seeing teaching as a tick box exercise rather than an enjoyable part of their job. This is compounded by the fact that many doctors who are expected to teach have little time set aside for it and find themselves teaching in opportunistic settings, such as in clinic or on ward rounds. This in turn can make a busy clinic feel busier and a long ward round feel longer. Also, students may appear for a day for teaching and then disappear to another task, leaving the teacher feeling unfulfilled in his or her role as a teacher by not being able to experience a student’s development over time and gain some satisfaction from this.
Use of role models by medical educators has a major impact on teaching. “As people often teach the way they were taught, medical educators should model these educational principles with their students and junior doctors.” 2 Most doctors will remember times in their training when they were taught by a good and enthusiastic teacher, and this in itself may even have led them towards a certain career pathway. How then do we as doctors, with little knowledge of how to teach and difficulty in finding time to teach, give our students that same experience?
How to . . .
“One of the most important principles of good teaching is planning. Far from compromising spontaneity, planning provides structure and context for teacher and pupils, as well as a framework for reflection and evaluation.”3 Many papers have been written about how best to teach in different settings,45 and many courses to promote good teaching are available. These can be used as a starting point for planning teaching.
While students are at medical school they are exposed to a vast array of teaching styles and assessments. The learning styles include large group or lecture based teaching, problem based learning, small group teaching, practical sessions, as well as various types of opportunistic based teaching, such as during ward rounds or in clinics. Types of assessment include exams, end of firm assessments, workplace assessments, vivas, and practical assessment of clinical examination skills (PACES). The emphasis placed on certain learning styles and assessments changes, sometimes on a yearly basis. It is therefore important to be adaptable as a teacher and to keep up to date with current procedures.
Spencer highlighted the importance of being aware of what a student knows already3: the “quality of resulting new knowledge depends not only on ‘activating’ this prior knowledge but also on the degree of elaboration that takes place.” It helps to bridge between existing and new information.
It is also important to understand how students learn and what your role is as a teacher, and adapt your teaching accordingly. Knowles interpreted the concept of andragogy and looked at the way adult learning differs from that of children.6 He made five assumptions about adult learning:
Adults are independent and self directing
As people mature they accumulate a reservoir of experience that becomes an increasing resource for learning
Adults value learning that integrates with the demands of their everyday life
As a person matures the orientation towards learning shifts from one of subject centeredness to one of problem centeredness
Adults are more motivated to learn by internal drives rather than external ones
Kaufman highlights areas of learning theory.2 One of these theories is constructivism, which has important implications for teaching and learning. “The teacher is not viewed as a transmitter of knowledge, but as a guide who facilitates learning.” It highlights the fact that “teachers should provide learning experiences that expose inconsistencies between students’ current understandings and their new experiences. Teachers should engage students in an active way, using relevant problems and group interactions.” Bain highlights the importance of helping students learn outside the class, by clarifying and simplifying a subject to enable students to read or study more complex material.7 It is also important to summarise what was taught and learnt during the session8 and to also ensure that there is an opportunity to ask questions and resolve any confusion.9
Teaching is a valuable opportunity to be involved in the training of tomorrow’s doctors and our future colleagues, not only by imparting knowledge but also by providing them with the real world experience on what it is to be a doctor and, of course, a teacher.
Competing interests: None declared.