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RECRUITING senior medical educators to Australia from overseas may provide them with a new and stimulating environment, but it can be a time-consuming and expensive process.
This whole process could be circumvented by producing a sufficient faculty of Australian senior medical educators.
The lack of a defined pathway for doctors to specialise in medical education combined with the traditional model in which clinicians with no educational training do the teaching leads to the risk that medical students and junior doctors may be exposed to poor-quality teaching experiences.
In the UK, the Academy of Medical Educators was formed in 2006 to set professional standards for medical educators. The academy also provides educational activities and resources for educators.
Such an academy could be replicated in Australia with the aim of increasing professional recognition for those who are interested in pursuing a career in medical education.
While most clinicians in the UK are involved in medical education to an extent, those with particular enthusiasm, aptitude and interest in teaching can gain recognition for their skills in the form of membership or fellowship of the academy.
Clinicians can individually negotiate teaching time with departmental directors as part of annual job plan and performance reviews. Within National Health Service (NHS) hospitals, clinicians receive equal payment for sessions spent on teaching activities as for clinical sessions such as ward rounds, outpatient clinics and theatre sessions.
This is an important difference between the UK and Australia, where some clinicians have contracts with universities for medical student teaching distinct from contracts for their clinical work, with teaching renumerated at a significantly lower rate. This is a major disincentive to clinicians to teach, with the separation of clinical and educational activities sending a negative message regarding the value of medical education.
Teaching activities are thought to be valued less by universities than research and less by hospitals than clinical work. Clearly funding is a major factor in this issue, with teaching unable to compete for funding on a level playing field with the other roles of academics and clinicians.
Yet many academics take on the combined roles of research and teaching, and the value of scholarship in teaching is often under-recognised.
In the UK there is increasing emphasis on equipping clinicians to be high-performing educators. Many educators undertake graduate certificates, diplomas or masters degrees in medical education — another avenue which should be encouraged for clinicians who wish to have significant involvement in medical education in Australia.
Moves in the UK to consider registering clinicians as educators/trainers with local deaneries based on a portfolio of evidence are underway. GPs are already registered with the UK General Medical Council as trainers or non-trainers.
There is a view that all doctors can and should teach. This assumes all doctors will be good at teaching. For this to be true all doctors should be accredited as educational supervisors based on their attendance at local training sessions, which could teach the basics of experiential learning, adult learning styles, feedback and assessment as the bare minimum skill set needed by a medical educator. For senior medical education leaders, more advanced training would be required.
Medical education faculty development programs have had a high level of participant satisfaction and positive outcomes in terms of leadership positions sought and new courses developed.
Medical education leaders need to form a long-term strategy for the recruitment and retention of future Australian senior medical educators. My suggestions aim to raise the status and continue the increasing professionalism and accountability of medical education in the interim.
Professor Julian Wright is director of medical student education, Rural Clinical School, University of Melbourne Medical School. He was previously director of postgraduate medical education at Central Manchester University Hospitals NHS Foundation Trust, UK. He is a fellow of the UK Academy of Medical Educators.
There are two types of learning – one is the kind that teaches us what NOT to do, the other is the type that teaches us how to go about doing what we SHOULD be doing. It is the latter which hopefully, will create a good clinician in the most reliable way. Just teaching someone what NOT to do will not necessarily teach them what they should be doing!
That said, it stands to reason that if a doctor is busy earning a living, non-dedicated teaching will be brief and possibly, less focused and considered. I certainly support the concept of adequate payment for good teaching. However, the quality of the teacher should be assessed as closely as the quality of the student learning!
In addition, skills we can all learn by attendance at fairly brief courses in teaching techniques will certainly improve the quality and efficiency of the way we teach. Regardless of whether a potential teacher has already tried such a course, I would have thought that any payment for teaching should require an initial observation/assessment of the teacher’s ability (untutored or tutored prior to assessment) and then a subsequent attendance at a teaching course of some sort, should the teaching skills demonstrated be found less than satisfactory ( or with potential for significant improvement).
‘Doktos’ may mean teacher, but it doesn’t necessarily mean a good one. If we want to identify teaching as an area worth paying for (as good teaching should be), let’s set a standard of practice first!
Aggree with all of the above. I am a clinical teacher and enjoy the interaction. But it MUST BE SAID, you will NOT get clinical teachers from General Practice if you don’t pay them a reasonable rate. The Uni of NSW has stopped payment to GPs. So where are you going to recruit them? Overseas? Generosity will not pay your bills or put bread on your table. So maybe the government should decrease their payment and give some to the GP educators. Or some of the perks they get when they retire
It is no coincidence that the Hippocratic oath begins with the premise that all doctors should be teachers. This meshes very nicely with the current philosophy of medical education, that all medical students and junior doctors should be prepared to be lifelong learners.
There is no need to assume that all doctors would be good at teaching, given that there is an explicit aim that all doctors are good at learning. Some will be suited for didactic lecturing, others to Socratic tutorials, and others to one on one experiential teaching/learning. in my career I have learned some of my most valuable lessons from those who were neither good teachers nor good doctors, simply by learning what not to do.
The fundamental skill of medicine is communication – having diagnosed hypertension, it is expected that a basically competent doctor will explain to the patient the needs for treatment, including the rationale for treatment as well as the mechanics of how to treat, individualised to the comprehension level of the patient. The doctor will then formulate a plan for assessing the patient’s compliance and understanding, by various subjective or objective measures, and vary the plan accordingly. Any doctor capable of explaining this to a patient, should be capable of explaining it to a medical student or registrar, at an appropriate level for their understanding. This sounds rather like ‘teaching’, without all the ‘medical educator’ mystique.
Those who wish to be specialist educators can obtain higher qualifications, but the universites are failing if they are not training every single doctor to be effective as a one to one teacher.
Teaching – it’s not rocket surgery.