Doctors as teachers
September 2006
The challenges to teaching in the medical profession
The provision of teaching in the medical profession in the UK remains an area of concern for a number of reasons including:
A lack of appropriate teacher education
All doctors are obligated to teach, yet there are no mandatory teacher education programmes and doctors have traditionally not received any formal training or teaching qualifications (eg postgraduate certificate in education).[Go to notes 2, 3, 4, 5, 6, 7 and 8] Although subject expertise is important, it is unacceptable to assume that because a doctor knows a lot about their subject, this will enable them to teach it effectively either formally or informally. This leads to problems of accountability, quality assurance and a lack of recognition of their role as teachers. Teaching in the medical profession requires a proficient knowledge of how to motivate the learner, assess competence, give constructive feedback, teach multiple trainee levels, and the skill to deal with competing demands of patient care, research and education. A lack of appropriate teacher education leads to problems with teaching methods. These include a lack of clear objectives, an over-emphasis on factual recall rather than on development of problem solving skills, the use of passive observation rather than active participation of learners, and teaching being pitched at the wrong level. At undergraduate level, the teaching provided by medical academics often focuses on the teacher’s area of research rather than providing a comprehensive overview of the subject. Evidence suggests that clinical teaching can be variable and unpredictable, poorly supervised and assessed, often opportunistic and may use approaches such as humiliation and sarcasm.[Go to notes 7, 18 and 19]
Time pressures
With increased patient and administrative loads, and the requirement to conduct research, doctors have a number of competing demands that often mean there is insufficient time for preparation and teaching.[Go to notes 20 and 21] These pressures on doctors and healthcare institutions are likely to continue to increase. [Go to note 22] The new consultant contract may potentially see teaching formally competing with other non-clinical responsibilities including CPD, audit and research. [Go to notes 20]
A lack of recognition and reward
The service provided by doctors who teach is often poorly rewarded in terms of remuneration and time allocated to teaching. Doctors are under unprecedented pressure to meet clinical care targets, manage resources and maintain administration procedures. Medical academics are commonly primarily employed for their contributions to research and are poorly compensated for their role as teachers. A doctor is unlikely to be appointed to a job or achieve a promotion solely on the basis of their teaching skills and experience. Encouragement and motivation of medical teachers is limited, and doctors face both internal and institutional constraints that prevent them from teaching.[Go to note 7] These problems are a part of a profession-wide lack of recognition of the importance of teaching.
Funding and support
There is a lack of investment and transparency in the funding for the teaching of medical students and doctors. In many institutions, the support for education and teaching is suboptimal, and problems occur when there is a lack of teaching resources.[Go to note 6] There is anecdotal evidence that funding provided for medical education is used instead for research purposes.[Go to note 23] Educational activities are not as pro-actively supported and nurtured due to the lack of institutional incentives like those available for undertaking research. A significant proportion of undergraduate teaching is now being devolved to the NHS which is already under pressure to meet clinical targets.
Changing patterns of healthcare and societal values
The evolving nature of the healthcare system in the UK and the changing attitudes and expectations of society on the role and performance of doctors has significant implications for the way medical students and doctors are taught. New therapies and techniques are being developed at an unprecedented rate. As a result doctors are constantly required to develop new clinical skills that subsequently need to be taught to medical students and junior doctors. The expansion of student numbers, the development and implementation of integrated medical curricula, and the increasing emphasis on self-directed and problem-based learning alter the way in which medicine needs to be taught.
Practical difficulties
There are a number of practical difficulties that limit the effectiveness of teaching in the medical profession including reduced opportunities to teach (shorter hospital stays; patients too ill or too frail; more patients refusing consent), insufficient resources and a lack of ‘teacher friendly’ clinical environments.[Go to note 6]