Riding the wave

Abstract

The Asia Pacific Medical Education Conference (APMEC) held in January this year celebrated 10 years of continued success. Hosted by the Medical Education Unit at the National University of Singapore Yong Loo Lin School of Medicine, the APMEC has grown to become the premier annual medical education event in the eastern hemisphere. One striking feature of the conference was the confluence of themes presented by the keynote speakers, most of whom were visiting from the West. No fewer than three referred to a compelling 2010 paper in the Lancet that warned of dire consequences if we continue to give our students fragmented teaching from the isolation of our disciplinary silos.1 Fittingly, the winner of the conference's prize for the best oral presentation (Dr Ngim Chin Fang from Monash University, Malaysia) addressed exactly this issue by describing an innovative programme that brings together major clinical specialties such as paediatrics, obstetrics & gynaecology, psychiatry and general practice to teach a case-based model that is both effective and sustainable.2 Another frequent refrain at the APMEC conference was that the medical educator needs to reconsider their teaching style. It is 20 years since Alison King coined the phrase ‘from sage on the stage to guide on the side’, reminding us that educating contemporary students is less about transmitting knowledge in didactic lecture format, and more about facilitating active learning through a variety of student-centred techniques.3 One thing that is more apparent in 2013 than it was in 1993 is that the clinical teacher is at risk of becoming not so much a ‘sage on the stage’ or a ‘guide on the side’ as a ‘…”pleb” on the Web’. The shift to online-learning Web 2.0 applications such as video sharing, social media and blogs, and massive open online courses (MOOCs) means that students are able to access the knowledge content of their courses from a huge variety of sources beyond the control of a set curriculum. Rather than reducing the role of the clinical teacher to a disembodied voice on the Internet, this change in the origins of student knowledge confirms the clinical teacher's role as the source of wisdom. Being the font of all knowledge was always a limiting role for the clinical teacher; now that the World Wide Web has assumed that dubious distinction, the clinical teacher is free to work with the student in sorting, appraising and assimilating that knowledge into meaningful understanding. After all, information management is what clinicians do best. This issue of The Clinical Teacher has amongst its themes a collection of papers on the varied roles that clinical learners can play in facilitating their own education and developing their teaching skills. As digital natives, today's students are well placed to integrate information from this melange of media. Alexopoulos et al. from Imperial College in London have discovered that 82 per cent of UK medical schools are offering teacher training to their students, indicating that this skill set is being seen as a valuable one for contemporary practice.4 Qureshi and colleagues from Edinburgh have found that junior doctors are highly valued by their junior peers as bedside teachers, perhaps not having the wisdom of an experienced clinical teacher, but making up for it in approachability and awareness of what's relevant.5 And Nwosu and colleagues from Liverpool have given students the novel role of writing their own examination questions as a way of ensuring that they engage with the aged care curriculum.6 All of these initiatives develop the students’ qualities as educators, ready to undertake this aspect of their future role on their own terms. It is easy to see that today's student – connected as they are to so many sources of information – need to become expert in knowledge management for the benefit of both their future patients and learners. They need to become vital nodes in the information network that flows around us all. In their first week of medical school, students at this university are challenged to work in their peer learning groups to construct a definition of ‘the good doctor’ after a range of activities exposing them to role models, both good and bad. The qualities that they use to define doctors who are ‘good’ are combined, analysed for frequency and presented back to the entire year level of 330 students as a ‘word cloud’, with the predominant words displayed most prominently. This year, ‘knowledge’ and ‘competence’ made modest showings, but one word dominated the word cloud by a significant margin. One word that, in the eyes of these novitiates to the profession, represented the quality that most distinguishes good doctors from the rest: ‘communication’. When they start work in 2017, these new doctors will understand that a key aspect of doing their job well is facilitating the transfer of information: as it ever was.