MED-NET Conference 1997. Rotterdam, the Netherlands.
Proceedings 4.2.

Teacher Education for Medicine in the United Kingdom

Z.J. Playdon (London, United Kingdom)

Provision

The UK market leaders for the provision of teacher education in the United Kingdom are undoubtedly the University of Dundee and the University of Cardiff. Both institutions offer programmes of study which lead to certification of diploma or master's degree, and which are delivered either by distance learning or by block attendance and self-study.

There are many other providers of short courses, typically from a day to a week in duration, where participants attend lectures on the principles of education and workshops where they use role-play, simulation and other small-group activities. General Practitioners who wish to have postgraduate doctors in their practices are obliged to complete such a course, as well as having their practices inspected to ensure that they meet the resource  requirements laid down: such programmes are managed through the UK's Deans of General Practice. The Royal College of Surgeons provides similar short courses for its members and many private training providers, medical schools and other agencies run programmes of this kind, either commercially or internally for their own staff.

Recent National Issues

Recently, however, there has been a new national focus on the quality of teaching in medicine. In 1994 the Standing Committee on Postgraduate Medical and Dental Education (SCOPME) report Teaching Hospital Doctors and Dentists to Teach concluded that 'hospital doctors and dentist need training in order to teach better' (1), a view that was supported a year later by the General Medical Council's (GMC) recommendation that 'if you have special responsibilities for teaching, you should develop the skills of a competent teacher' (2). Concurrent with these demands on postgraduate education, there was an increasing focus on the quality of teaching and learning in the undergraduate sector, demonstrated in publications from agencies such as the Higher Education Funding Council (3) (HEFC), the Committee of Vice-Chancellors and Principals (4) (CVCP) and the Higher Education Quality Council (4) (HEQC).

Innovative Response of UMDS

Principles
The response of the United Medical and Dental Schools Guy's and St Thomas' (UMDS) was to create a new Certificate in Teaching for Medicine and Dentistry to improve the quality of teaching in medicine. Its approaches are those of mainstream professional educationists, that is specialists in education, qualified to the level of PhD, whose experience is in university  departments of education and a wide range on teaching and research contexts. It operates not by sending people on courses to learn theory or simulate real life through role-play, but by watching them teach in their normal working life and discussing what happens with them.

The programme recognises that although its participants might not have and any formal teacher training they have, nonetheless, been teaching for some time and that new learning must build on that experience. Further, a fundamental consideration was that provision must operate within the ethical principles both of education and of medicine. It is these  principles - confidentiality, empowerment, 'to help or at least not to harm' (6) for example  which provide the core, philosophy and methodology of the UMDS Certificate in Teaching.

Attendance at the short courses and workshops which are already in place in many institutions, utilising either internal resources or external providers demonstrates interest in and commitment to a teaching role. However, since they take place away from the teacher's normal working context they are divorced from the lived realities of the daily practice of medicine. A key design feature of the Certificate programme, therefore, was the  reaction of evidence of teaching and learning in real-life educational environments. The processes which it uses have been designed to reflect the way in which doctors and dentists learn in their clinical working environment. Central to that is the idea of the "professional conversation" (7) - the on-going interchanges about patient, principles and procedures - in which senior professionals exchange information and ideas with their peers, in their own and other clinical specialities.

The theory which informs the Certificate is one in which individuals are encouraged to recognise and develop their own specific learning agenda, that is, the self-same philosophy found underpinning 'student-centred programmes' and 'self-directed learning'. The intention is to enable participants to reflect on what constitutes satisfactory teaching and learning and in so doing, to encourage them to consider the principles and values of education as well as the practical contexts of medical and dental education.

This is an approach which is often under-represented in medical and dental education, where a mechanistic model of learning is more usually advocated, typified by Margetson (1996) as:

since knowledge is securely anchored in empirical reality, to know something is to be in possession of information which has been shown to be true. It provides the secure foundation for professional practice. Consequently, the teacher's task is to transmit this information as efficiently as possible, and the learner's task it to absorb it as efficiently as possible (8).

By contrast, the Certificate seeks to draw attention to views such as those provided by Stones (1992) in his work Quality Teaching:

Few, surely, would disagree that teachers should have a good grasp of subject knowledge and should be familiar with schools and classrooms. However, the 'delivery' view of teaching grossly oversimplifies its true nature, and the prescriptions intended to improve it are doomed to fail  because of the lack of understanding of its complexities (9).

And

Quality teaching cannot be a-theoretical, nor can it be nurtured by disquisition on the nature of teaching by theorists with their head in the clouds. Both theory and practice are essential. Indeed they are inseparable (10).

Practice
The Certificate creates evidence of teaching quality in real-life learning environments. It operates by the observation of a teacher's teaching by an educational adviser and the use of that observation as the basis for the professional conversation which provides support to the teacher. The teaching observations focus on four  key areas in teaching: interpersonal skills, communication skills, classroom management and learner management. At present, this cycle is running out at two or three observation sessions before a satisfactory standard of teaching is recognised.

In practice, a consultant will decide that they wish to go through the Certificate programme. So, they will make contact with an education adviser who will discuss with them the teaching which they would like to be observed on ward-round, in out-patients, at a lunchtime meeting, in theatre or any other context where their normal clinical duties, and thus their teaching, takes place. At the pre-arranged time, the education adviser will join the consultant at the hospital and will take them through the first cycle of observation and professional conversation.

As indicated earlier, the aim is to enable the individual themselves to reflect on their purposes and processes, to consider whether their actions produce the results they desire and to advise them in finding ways and means which work well for them and their students. Implicit in this is the principle which termed the 'fractile model', the approach which reminds teachers of what it is to be a student, and makes real the humanistic imperative of 'do as you would be done by' (11).

Thus this cycle of observation and professional conversation could be described as a 'master-class'. It is tailored to the needs of the individual and to the real issues which they have in their working environment - issues which reflect the speciality they work in, the nature of their Trust and their own experience of and assumptions about teaching. From a management point of view, the Certificate is carried out in the workplace, both to allow learning to take place in a real-life, real-time context and to make the process amenable to the service commitment required of medical education. Thus, it is extremely cost-effective, since it avoids the costs of locum cover and travel associated with course attendance. Further, it avoids disrupting continuity in either learning for student or care for patients. Finally, because the processes which we use are those utilised by mainstream professional teacher education, accreditation is linked to mainstream quality standards. 

References:

1. Standing Committee on Postgraduate Medical and Dental Education (1994). Teaching hospital doctors and dentists to teach. London. SCOPME. p2.
2. General Medical Council (1995). Good Medical Practice. London. GMC. Para. 10.
3. For example, Higher Education Funding Council (June 1994) Further developments of the method for the assessment of the quality of education. London. HEFCE.
4. For example, Cryer, P. (February 1993). Preparing for Quality Assessment and Audit. London. CVCP.
5. For example, Higher Education Quality Council (1994). Guidelines on Quality Assurance. London. HEQC.
6. See Goodsman, D. & Playdon, Z.J. (1997). Education or Training: Medicine's Learning Agenda. BMJ. 29 March 1997.
7. Playdon, Z.J. & Goodsman, D. (1996). The Myth of Medical Education. Paper given at AMSE Annual Conference. September 1996.
8. Margetson, D. (1996). Beginning with the Essentials: Why Problem-based Learning Begins with Problems. Education for Health. Vol. 9. No. 1. 61-69. p 66.
9. Stone, E. (1992). Quality Teaching: a sample of cases. London: Routledge. p.3 .
10. Stone, E. (1992). p. 4.
11. For a discussion of this principle as it appears: in the moral codes of different cultures. See Aldous Huxley (1946). The Perennial Philosophy. London. Chatto & Windus.

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