The ordinariness of teaching

Abstract

This issue of the journal presents papers covering aspects of student learning and the teaching experience. All of us are interested in how our students are progressing and in what they think about the educational activities we provide for them, but how often do we really know what our students are thinking? A Letter to the Editor starts the proceedings: Bridgens, now a qualified doctor, writes with feeling about some of his experiences as a student, decrying teachers and educationalists for the gloss we put on our practice when the reality, at least for some students some of the time, is a far remove from the theory. His main complaint focuses on the practical delivery of clinical teaching, pointing out both its regular failure to occur and its haphazard nature, resulting in feelings of depression and demotivation amongst students. He resolved to do better as a teacher himself when qualified and writes that teaching must become recognised as an essential and important part of a doctor's duty and not just seen as an afterthought. He recognises that protected time is required to ensure this and to make sure that teaching brings life to the ordinariness of everyday clinical practice rather than be seen as an extra duty.1 In reply, Sam Leinster, Dean of a new medical school in England draws on the results of the inspections of all medical schools in England during the period 1998–2000 by the Quality Assurance Agency. Those inspections rigorously examined how teaching was delivered at each school. Of all the criteria examined, Quality Management and Enhancement was the commonest area of weakness with very few schools achieving full marks for the provision of suitable systems to monitor quality of teaching. Whilst the responsibility for the delivery of teaching rests clearly with the teacher, both Bridgens and Leinster point out the problems faced in trying to achieve quality in a system that is under pressure. One part of the solution is to ensure that teaching becomes a fixed part of the service contract for clinicians. Leinster recognises that this will not work for all, with ‘pressed men’ less likely to achieve good results than those with interest and ability in teaching. Another part of the change process includes improving monitoring and management systems within the teaching environment, with the routine collection of student views a central part of the data set. Collecting data is not sufficient in itself and management systems that allow rapid action and feedback to students and teachers are essential to ensure that the teaching ‘system’ learns from its mistakes and continues to grow.2 Why does this matter? Well, for many of us our choice of career within medicine was based on positive experiences we had as students during our clinical attachments. These experiences may have been with a particular patient or groups of patients, with an aspect of technology, the intellectual challenge offered by a certain discipline or, and I think quite commonly, by the influence of a particular role model clinician or teacher. Fortunately, the experiences described by Bridgens are balanced by some at the other end of the scale, and this month McParland and her colleagues in London describe the effects of a psychiatric attachment on how students viewed a potential career in psychiatry.3 They asked students from both a problem based and a traditional curriculum about their career intentions and their attitudes to psychiatry before and after an eight week clinical rotation. They found that specific experiences during the attachment significantly influenced the development of positive attitudes towards a career in the specialty – amongst these positive experiences were receiving encouragement from consultant teachers and being directly involved in patient care. What can we learn from this debate? Medical students, like all other human beings respond warmly to positive stimuli, and react to negative environments by withdrawal and adopting defensive attitudes. It is the teacher's responsibility to establish a learning environment that encourages learning, and planned, structured learning activities and teaching are key components of this environment whatever educational philosophy underpins the curriculum in vogue. There is no place for the haphazard, the unprepared or the absent teacher in contemporary medical education. But just like medical students, medical teachers too need a positive working environment in which to flourish and use their skills to the full. Who is responsible for ensuring this?