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Medical Education 1987. 21, 457 Editorial Teaching medical teachers to teach We know that doctors have always been teachers from the very start: after Aesculapius went to the centaur Cherion to be taught ‘the ways ofhealing diseases’, the doctors succeeding him learnt from other doctors; Hippocrates went to Cos; Galen at 17 went to the medical school in his home town Pergamos. Is it the case that medical teachers receive too little training and have too little aptitude for their teaching tasks? The charge has been expressed repeatedly, sternly and strongly (Miller 1980). By general agreement, little account is taken of a medical teacher’s pedagogic abilities. Medical teachers are rarely, if ever, evaluated sys- tematically as they handle their ‘teaching load’. The professional and material rewards that come their way are for professional achievement in practising their branch of medicine or for pro- ductivity as scientists, basic or clinical. These facts are so well known as to be platitudes. There is now also widespread acceptance that medical education has to change, for many rea- sons: diseases and patients change; health care is delivered in different ways; the other health pro- fessions claim their expanding place for which doctors must allow; and economics ofhealth care have become an overriding issue. Ethical matters intrude which formerly were hardly evident or recognized (Doxiadis 1987). How are the great reorientations now called for to be effected when the teachers of future doctors are not themselves sufficiently proficient as teachers? It is scarcely good enough to talk and write about medical teacher training (or ‘faculty development’ in the North American phrase) when no system is envisaged for assessing sytematically the teaching abilities of all medical teachers, analysing the data thus accumulated, diagnosing strengths and deficits of individual instructors, and administering remedial courses. There is little evidence that such large undertak- ings are imminent. But what is sure, particularly visible on the international scale, is that proper rewards (and penalties) in the teaching sector are pressingly necessary. Performance indicators of adequate teaching ability have to be developed: that is perhaps a main emphasis generally heard as countries look to reform of the medical schools. In some countries promising initiatives have already been taken, such as the informative survey in the UK (Macrae et a2. 1987). Another cause for concern is the frequency with which medical students are poorly motivi- ated to learn. The relationship between student sluggards on one hand and inept, desultory medicai teachers on the other is certainly not a simple equation. The sociology of medical schools as institutions has its profound effects: medical teachers, for one thing, are immured in their separate disciplines. Robert Petersdorf writing recently (Vivier 1987) insisted that in addition to the present ‘traditional researchers’ an entirely new second cadre of ‘clinician-teachers’ must be developed. Their expertise (if they come into being as a cadre, rather than as now when they strive individually as isolates in every medi- cal school) will be to counteract the commou research finding that ‘. . . many teaching sessions, especially ward rounds, were haphazard, mediocre, and lacking in intellectual excitement’ (Daggett et a/. 1987). The report of the Conference dealing with ‘The doctor as teacher’ in this Issue (pp. ~IZ-ZO) signals progress greatly overdue towards respon- sibility and professionalism in the teaching com- mitment of doctors References Daggett C., CassieJ. & Collins G. (1979) Research on clinical teaching. Review of Educational Research 49. I 5 1-69. Doxiadis S. (ed.) (1987) Ethical Dilemmmas in Health Promotion. John Wiley & Sons, Chichester. Macrae R.E., Gunn J.M. 81 Harden R.M. (1987) Improving Teaching Competence. Association for the Study of Medical Education, Dundee. Miller G.E. (1980) Educating Medical Teachers. Harvard Umversity Press, Cambridge, Massachusetts. Vivier C. (ed.) (1987) Flexner: 7sYears Later. Univer- sity Press of America, Boston. 457

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Page 1: Teaching medical teachers to teach

Medical Education 1987. 21, 457

Editorial

Teaching medical teachers to teach We know that doctors have always been teachers from the very start: after Aesculapius went to the centaur Cherion to be taught ‘the ways ofhealing diseases’, the doctors succeeding him learnt from other doctors; Hippocrates went to Cos; Galen at 17 went to the medical school in his home town Pergamos.

Is it the case that medical teachers receive too little training and have too little aptitude for their teaching tasks? The charge has been expressed repeatedly, sternly and strongly (Miller 1980).

By general agreement, little account is taken of a medical teacher’s pedagogic abilities. Medical teachers are rarely, if ever, evaluated sys- tematically as they handle their ‘teaching load’. The professional and material rewards that come their way are for professional achievement in practising their branch of medicine or for pro- ductivity as scientists, basic or clinical. These facts are so well known as to be platitudes.

There is now also widespread acceptance that medical education has to change, for many rea- sons: diseases and patients change; health care is delivered in different ways; the other health pro- fessions claim their expanding place for which doctors must allow; and economics ofhealth care have become an overriding issue. Ethical matters intrude which formerly were hardly evident or recognized (Doxiadis 1987).

How are the great reorientations now called for to be effected when the teachers of future doctors are not themselves sufficiently proficient as teachers? It is scarcely good enough to talk and write about medical teacher training (or ‘faculty development’ in the North American phrase) when no system is envisaged for assessing sytematically the teaching abilities of all medical teachers, analysing the data thus accumulated, diagnosing strengths and deficits of individual instructors, and administering remedial courses. There is little evidence that such large undertak- ings are imminent.

But what is sure, particularly visible on the international scale, is that proper rewards (and penalties) in the teaching sector are pressingly

necessary. Performance indicators of adequate teaching ability have to be developed: that is perhaps a main emphasis generally heard as countries look to reform of the medical schools. In some countries promising initiatives have already been taken, such as the informative survey in the UK (Macrae et a2. 1987).

Another cause for concern is the frequency with which medical students are poorly motivi- ated to learn. The relationship between student sluggards on one hand and inept, desultory medicai teachers on the other is certainly not a simple equation. The sociology of medical schools as institutions has its profound effects: medical teachers, for one thing, are immured in their separate disciplines. Robert Petersdorf writing recently (Vivier 1987) insisted that in addition to the present ‘traditional researchers’ an entirely new second cadre of ‘clinician-teachers’ must be developed. Their expertise (if they come into being as a cadre, rather than as now when they strive individually as isolates in every medi- cal school) will be to counteract the commou research finding that ‘. . . many teaching sessions, especially ward rounds, were haphazard, mediocre, and lacking in intellectual excitement’ (Daggett et a / . 1987).

The report of the Conference dealing with ‘The doctor as teacher’ in this Issue (pp. ~IZ-ZO) signals progress greatly overdue towards respon- sibility and professionalism in the teaching com- mitment of doctors

References

Daggett C., CassieJ. & Collins G. (1979) Research on clinical teaching. Review of Educational Research 49. I 5 1-69.

Doxiadis S. (ed.) (1987) Ethical Dilemmmas in Health Promotion. John Wiley & Sons, Chichester.

Macrae R.E., Gunn J.M. 81 Harden R.M. (1987) Improving Teaching Competence. Association for the Study of Medical Education, Dundee.

Miller G.E. (1980) Educating Medical Teachers. Harvard Umversity Press, Cambridge, Massachusetts.

Vivier C. (ed.) (1987) Flexner: 7sYears Later. Univer- sity Press of America, Boston.

457